Barriers inhibiting effective detection and management of postpartum hemorrhage during facility-based births in Madagascar: findings from a qualitative study using a behavioral science lens.
Barriers inhibiting effective detection and management of postpartum hemorrhage during facility-based births in Madagascar: findings from a qualitative study using a behavioral science lens.
复制标题
DOI：
10.1186/s12884-021-03801-w
复制
发表时间：
2021-04-22
影响因子：
3.1
通讯作者：
Smith J
中科院分区：
文献类型：
--
作者：
Flanagan SV;Razafinamanana T;Warren C;Smith J
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries, and is the most common direct cause of maternal deaths in Madagascar. Studies in Madagascar and other low-income countries observe low provider adherence to recommended practices for PPH prevention and treatment. Our study addresses gaps in the literature by applying a behavioral science lens to identify barriers inhibiting facility-based providers’ consistent following of PPH best practices in Madagascar. In June 2019, we undertook a cross-sectional qualitative research study in peri-urban and rural areas of the Vatovavy-Fitovinany region of Madagascar. We conducted 47 in-depth interviews in 19 facilities and five communities, with facility-based healthcare providers, postpartum women, medical supervisors, community health volunteers, and traditional birth attendants, and conducted thematic analysis of the transcripts. We identified seven key behavioral insights representing a range of factors that may contribute to delays in appropriate PPH management in these settings. Findings suggest providers’ perceived low risk of PPH may influence their compliance with best practices, subconsciously or explicitly, and lead them to undervalue the importance of PPH prevention and monitoring measures. Providers lack clear feedback on specific components of their performance, which ultimately inhibits continuous improvement of compliance with best practices. Providers demonstrate great resourcefulness while operating in a challenging context with limited equipment, supplies, and support; however, overcoming these challenges remains their foremost concern. This response to chronic scarcity is cognitively taxing and may ultimately affect clinical decision-making. Our study reveals how perception of low risk of PPH, limited feedback on compliance with best practices and consequences of current practices, and a context of scarcity may negatively affect provider decision-making and clinical practices. Behaviorally informed interventions, designed for specific contexts that care providers operate in, can help improve quality of care and health outcomes for women in labor and childbirth. The online version contains supplementary material available at 10.1186/s12884-021-03801-w.
登录
查看更多内容
影响因子：
3.1
作者：
Natarajan A;Ahn R;Nelson BD;Eckardt M;Kamara J;Kargbo S;Kanu P;Burke TF
通讯作者：
Burke TF
DOI：
10.1363/3219206
发表时间：
2006-12-01
期刊：
INTERNATIONAL FAMILY PLANNING PERSPECTIVES
影响因子：
--
作者：
Prata, Ndola;Morris, Lco;Stehr, Mark
通讯作者：
Stehr, Mark
DOI：
10.1016/j.ijgo.2015.06.047
发表时间：
2016-01-01
影响因子：
3.8
作者：
Braddick, Louise;Tuckey, Victoria;Stokes, Tim
通讯作者：
Stokes, Tim
影响因子：
11.1
作者：
Bartlett, Linda;Cantor, David;Rosen, Heather E.
通讯作者：
Rosen, Heather E.
DOI：
10.9745/ghsp-d-14-00034
发表时间：
2014-08
期刊：
Global health, science and practice
影响因子：
--
作者：
Smith JM;Currie S;Cannon T;Armbruster D;Perri J
通讯作者：
Perri J