Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya.
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Kenya. The aim of this study was to measure quality and timeliness of care for PPH in a sample of deliveries in referral hospitals in Kenya. We conducted direct observations of 907 vaginal deliveries in three Kenyan hospitals...
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0001670 |
| _version_ | 1797703666135728128 |
|---|---|
| author | Emma Clarke-Deelder Kennedy Opondo Emmaculate Achieng Lorraine Garg Dan Han Junita Henry Moytrayee Guha Alicia Lightbourne Jennifer Makin Nora Miller Brenda Otieno Anderson Borovac-Pinheiro Daniela Suarez-Rebling Nicolas A Menzies Thomas Burke Monica Oguttu Margaret McConnell Jessica Cohen |
| author_facet | Emma Clarke-Deelder Kennedy Opondo Emmaculate Achieng Lorraine Garg Dan Han Junita Henry Moytrayee Guha Alicia Lightbourne Jennifer Makin Nora Miller Brenda Otieno Anderson Borovac-Pinheiro Daniela Suarez-Rebling Nicolas A Menzies Thomas Burke Monica Oguttu Margaret McConnell Jessica Cohen |
| author_sort | Emma Clarke-Deelder |
| collection | DOAJ |
| description | Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Kenya. The aim of this study was to measure quality and timeliness of care for PPH in a sample of deliveries in referral hospitals in Kenya. We conducted direct observations of 907 vaginal deliveries in three Kenyan hospitals from October 2018 through February 2019, observing the care women received from admission for labor and delivery through hospital discharge. We identified cases of "suspected PPH", defined as cases in which providers indicated suspicion of and/or took an action to manage abnormal bleeding. We measured adherence to World Health Organization and Kenyan guidelines for PPH risk assessment, prevention, identification, and management and the timeliness of care in each domain. The rate of suspected PPH among the observed vaginal deliveries was 9% (95% Confidence Interval: 7% - 11%). Health care providers followed all guidelines for PPH risk assessment in 7% (5% - 10%) of observed deliveries and all guidelines for PPH prevention in 4% (3% - 6%) of observed deliveries. Lowest adherence was observed for taking vital signs and for timely administration of a prophylactic uterotonic. Providers did not follow guidelines for postpartum monitoring in any of the observed deliveries. When suspected PPH occurred, providers performed all recommended actions in 23% (6% - 40%) of cases. Many of the critical actions for suspected PPH were performed in a timely manner, but, in some cases, substantial delays were observed. In conclusion, we found significant gaps in the quality of risk assessment, prevention, identification, and management of PPH after vaginal deliveries in referral hospitals in Kenya. Efforts to reduce maternal morbidity and mortality from PPH should emphasize improvements in the quality of care, with a particular focus on postpartum monitoring and timely emergency response. |
| first_indexed | 2024-03-12T05:08:54Z |
| format | Article |
| id | doaj.art-9613667bdd834a27895d70bd9e4d3f72 |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T05:08:54Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-9613667bdd834a27895d70bd9e4d3f722023-09-03T08:50:20ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752023-01-0133e000167010.1371/journal.pgph.0001670Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya.Emma Clarke-DeelderKennedy OpondoEmmaculate AchiengLorraine GargDan HanJunita HenryMoytrayee GuhaAlicia LightbourneJennifer MakinNora MillerBrenda OtienoAnderson Borovac-PinheiroDaniela Suarez-ReblingNicolas A MenziesThomas BurkeMonica OguttuMargaret McConnellJessica CohenPostpartum hemorrhage (PPH) is the leading cause of maternal mortality in Kenya. The aim of this study was to measure quality and timeliness of care for PPH in a sample of deliveries in referral hospitals in Kenya. We conducted direct observations of 907 vaginal deliveries in three Kenyan hospitals from October 2018 through February 2019, observing the care women received from admission for labor and delivery through hospital discharge. We identified cases of "suspected PPH", defined as cases in which providers indicated suspicion of and/or took an action to manage abnormal bleeding. We measured adherence to World Health Organization and Kenyan guidelines for PPH risk assessment, prevention, identification, and management and the timeliness of care in each domain. The rate of suspected PPH among the observed vaginal deliveries was 9% (95% Confidence Interval: 7% - 11%). Health care providers followed all guidelines for PPH risk assessment in 7% (5% - 10%) of observed deliveries and all guidelines for PPH prevention in 4% (3% - 6%) of observed deliveries. Lowest adherence was observed for taking vital signs and for timely administration of a prophylactic uterotonic. Providers did not follow guidelines for postpartum monitoring in any of the observed deliveries. When suspected PPH occurred, providers performed all recommended actions in 23% (6% - 40%) of cases. Many of the critical actions for suspected PPH were performed in a timely manner, but, in some cases, substantial delays were observed. In conclusion, we found significant gaps in the quality of risk assessment, prevention, identification, and management of PPH after vaginal deliveries in referral hospitals in Kenya. Efforts to reduce maternal morbidity and mortality from PPH should emphasize improvements in the quality of care, with a particular focus on postpartum monitoring and timely emergency response.https://doi.org/10.1371/journal.pgph.0001670 |
| spellingShingle | Emma Clarke-Deelder Kennedy Opondo Emmaculate Achieng Lorraine Garg Dan Han Junita Henry Moytrayee Guha Alicia Lightbourne Jennifer Makin Nora Miller Brenda Otieno Anderson Borovac-Pinheiro Daniela Suarez-Rebling Nicolas A Menzies Thomas Burke Monica Oguttu Margaret McConnell Jessica Cohen Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya. PLOS Global Public Health |
| title | Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya. |
| title_full | Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya. |
| title_fullStr | Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya. |
| title_full_unstemmed | Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya. |
| title_short | Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya. |
| title_sort | quality of care for postpartum hemorrhage a direct observation study in referral hospitals in kenya |
| url | https://doi.org/10.1371/journal.pgph.0001670 |
| work_keys_str_mv | AT emmaclarkedeelder qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT kennedyopondo qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT emmaculateachieng qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT lorrainegarg qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT danhan qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT junitahenry qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT moytrayeeguha qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT alicialightbourne qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT jennifermakin qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT noramiller qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT brendaotieno qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT andersonborovacpinheiro qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT danielasuarezrebling qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT nicolasamenzies qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT thomasburke qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT monicaoguttu qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT margaretmcconnell qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya AT jessicacohen qualityofcareforpostpartumhemorrhageadirectobservationstudyinreferralhospitalsinkenya |