Facility readiness and health workers’ preparedness to manage Postpartum Hemorrhage among Public Health Facilities within greater Kampala.

Abstract

Background: Globally, postpartum hemorrhage (PPH) is the leading cause of maternal deaths with the biggest burden occurring in low-resource settings. In Uganda, PPH accounts for 34% of all institutional maternal deaths reviewed. The likelihood of a mother dying from PPH is highest in the first 2 hours if she doesn’t access timely and appropriate interventions. The aim of this study was to determine the level of facility readiness and health workers' preparedness to manage PPH among public comprehensive emergency obstetric and newborn care (CEmONC) facilities within greater Kampala. Methodology: This was a cross-sectional study conducted among 14 public facilities from Kampala, Wakiso, Mukono, and Mpigi Districts. The study interviewed 191 health workers to determine knowledge on PPH management. We utilized a facility observational checklist to assess the availability of 7 indicators of readiness for PPH management. Adequate knowledge was measured as having a score of ≥75%, while a facility was considered ready to manage PPH if it had a composite score of ≥90%. Results: Diploma midwives constituted the majority of participants (42.4%) and less than a third of health workers had received any recent in-service PPH training. None of the health facilities studied was fully ready to manage PPH. The proportion of health workers with adequate knowledge of PPH management was low at 26.3% (95% CI; 20.2-33.2). The mean knowledge score was 65.4, significantly different among cadres and those with recent training (P value <0.001). Conclusions and recommendations: The study showed that all public facilities surveyed lacked the desired capacity to manage a PPH case, coupled with low PPH knowledge among health workers. We recommend that stakeholders address the gaps in human resources, medicines and supplies, equipment, and provider competence in PPH management to promote a reduction in maternal mortality and morbidity from PPH.