Development of a complex quality improvement intervention for timely blood transfusions for the management of post-partum haemorrhage in Africa

点击翻译按钮获取中文摘要

Catastrophic bleeding after childbirth-post-partum haemorrhage-is a leading cause of deaths among mothers worldwide. It is especially problematic in poor regions, such as Sub-Saharan Africa, where it causes almost 50,000 deaths each year. When a woman has severe post-partum 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 is because of many factors, starting 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 when a woman needs blood after birth, and blood not being safe or available. These problems must be tackled not only at transfusing facilities (facilities that provide blood transfusions) and blood banks, but in communities too. We are proposing a main study that aims to overcome barriers across the health system to increase births in health facilities that provide transfusions and to improve the supply and timely use of blood for the management of post-partum haemorrhage. However, some developmental work is necessary to design the best main study possible. This early-phase study will allow us to identify health facilities in Ghana and Uganda that are actively carrying out blood transfusions, or serving as blood banks, and to understand the key problems that these health facilities and communities face when it comes to providing timely blood transfusions for women with post-partum haemorrhage. In each country, information about barriers to providing high quality blood transfusion services will be obtained by speaking with staff from10 transfusing facilities or blood banks, 48-64 community members, and 4-5 representatives from the national blood transfusion services and the ministries of health. We will then convene national meetings to engage local stakeholders-community members, transfusing facility and blood bank staff, and staff from national blood transfusion services and ministries of health-so that they can input into the design of the main study. These meetings will harmonise stakeholders' knowledge of these barriers to providing transfusions for women with post-partum haemorrhage to guide the main study's activities. In the main study, community members and transfusing facility or blood bank staff will engage in quality improvement-identifying problems and creating and implementing solutions to these-to overcome those barriers. These processes will then be documented to help build scalable "packages" of solutions that can be implemented nationally to improve the quality of blood transfusion services. Stakeholder inputs will help design a main study intervention that will be feasible and acceptable to participants. Further, these inputs will be important for designing an intervention that will continue after the study funding has finished. Part of this continuation will come from the involvement of mentors who are already working within a leadership capacity with transfusing facilities and blood banks, rather than external facilitators from the study team, who will provide leadership and support to these facilities throughout the intervention. Overall, there will be enhanced links across the lower tiers of the health system, including communities, to increase childbirth in transfusing facilities, especially for women who most need it, and to improve the timeliness and quality of blood transfusions.