Developing quality improvement interventions for blood transfusions in the management of postpartum haemorrhage in Ghana and Uganda

Project 16 Apr 2020
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Catastrophic bleeding after childbirth (postpartum haemorrhage) is a leading cause of deaths among mothers worldwide. It is especially problematic in Sub-Saharan Africa where it causes almost 50,000 deaths each year. Risk factors for fatal postpartum haemorrhage, like anaemia, are common among pregnant women across Sub-Saharan Africa. However, these risk factors are not well understood at a community level, and high-risk women may not give birth in a facility where postpartum haemorrhage could be managed. 

When a woman has severe postpartum haemorrhage, she often needs a blood transfusion, ideally within one hour, to survive. However, blood does not always get to the women who need it, when they need it. This study aims to understand the barriers across the health system in terms of: identifying women most at risk of fatal postpartum haemorrhage; getting them to facilities where post-partum haemorrhage could be effectively managed; and identifying and managing post-partum haemorrhage when it does occur, including the use of blood transfusion.  

Many factors - from communities' reluctance to donate blood due to fear and stigma, women not seeking maternity care when they need it, health facility staff not recognising the severity of postpartum haemorrhage, and blood not being safe or available - contribute to deaths from postpartum haemorrhage. These problems must be tackled not only at the facilities that provide care for women during delivery and the postpartum period, but also in communities. This study will identify health facilities in Ghana and Uganda that offer comprehensive emergency obstetric care (including management of postpartum haemorrhage and use of blood transfusions) and the communities within their catchment area. We aim to then understand the key problems that these health facilities and communities face when it comes to providing care for women with postpartum haemorrhage. We are carrying out a two-part study, involving both a qualitative exploration of these problems and a quantitative assessment of facility readiness to manage postpartum haemorrhage and to carry out blood transfusions as necessary. Findings from this study will be used to design a future intervention, which will see quality improvement being applied across the health system to strengthen recognition and management of postpartum haemorrhage.