Assessment of quality of care for women with postpartum Haermorrhage in Hoima district : A client perspective

Abstract

Background: Quality of care for postpartum hemorrhage plays an important role in the reduction of maternal mortality. The Ministry of Health shows in its performance report 2015-2016, that postpartum hemorrhage (PPH) is a number one contributor to maternal mortality in Uganda. These therefore could be indicators of a problem in postpartum hemorrhage prevention and treatment in the aspect of quality of the services offered to clients. Objective: The objective of this study was to assess the quality of care provided to women with postpartum hemorrhage and the associated outcomes in Hoima district so as to formulate interventions to reduce maternal deaths due to postpartum hemorrhage in the district. Methods: A cross sectional study employing both quantitative and qualitative methods was conducted in four public health facilities in Hoima district between May and June 2018. It involved using a checklist to verify the availability of structural inputs, as well as an observation checklist to verify processes performed by health providers in care for women with PPH. An in-depth interview guide that was translated into the local language was used to collect qualitative data. Thirteen in-depth interviews were conducted with women who were purposively sampled. Quality of care for women with PPH was assessed based on the mean percentage scores for availability of inputs, and processes performed by health providers respectively. Data was summarized into percentage mean scores using STATA VERSION 14.0. Content analysis was employed in analyzing qualitative data. Results: Overall quality of care for women with postpartum hemorrhage scored as good given the mean index scores for availability of structural inputs (mean index score=84.4%). Similarly, quality of care in relation to processes performed by health providers scored as good given the overall (mean index score =77.7%) for all the processes performed. However for some structural inputs quality of care scored as average; availability of cold chain storage, (mean score =50%), and availability of PPH guidelines and protocols, (mean score =0%). Quality of care scored as poor in relation to performing of tasks like monitoring a woman’s bleeding, (mean score =48%), and provider client communication, (mean score =47.5%), administration of oxytocin within one minute (mean score =28.6%). Most of the clients interviewed in the in-depth interviews perceived quality of care for women with postpartum hemorrhage as good. Conclusion: Quality of care for women with PPH has areas that still need focus in relation to availability of structural inputs and processes performed by health providers. There is thus need for resource support in terms of distribution and dissemination of PPH guidelines, developing a mechanism of routine training and orientation of health providers on any updates and changes in the guidelines and training on communication skills, and ensuring availability of cold chain storage for oxytocin at the health facilities