Local health workers’ perceptions of substandard care in the management of obstetric hemorrhage in rural Malawi

Abstract

BackgroundTo identify factors contributing to the high incidence of facility-based obstetric hemorrhage in Thyolo District, Malawi, according to local health workers.MethodsThree focus group discussions among 29 health workers, including nurse-midwives and non-physician clinicians (‘medical assistants’ and ‘clinical officers’).ResultsFactors contributing to facility-based obstetric hemorrhage mentioned by participants were categorized into four major areas: (1) limited availability of basic supplies, (2) lack of human resources, (3) inadequate clinical skills of available health workers and (4) substandard referrals by traditional birth attendants and lack of timely self-referrals of patients.ConclusionHealth workers in this district mentioned important community, system and provider related factors that need to be addressed in order to reduce the impact of obstetric hemorrhage.

Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide

“…However, a policy of vaginal birth after cesarean delivery is justified because cesarean deliveries carry significant additional risks. 152 Our meta-analysis has the advantage of a large number of included patients. 45 Few cases had accessed arterial embolization despite reported high success rates.…”

Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi

“…In high-income contexts, lack of adequate out-of-hours care (which includes not just staff numbers, but also the skill mix and deployment of those staff) has been shown to leave women and neonates vulnerable [ 39 ]. In the Malawian context, maternal death reviews have highlighted human resources constraints and/or insufficient clinical skills as key factors that delay adequate and timely care [ 15 , 16 , 29 , 40 ]. These factors also have important consequences for health workers.…”

“…There is consistent evidence from high-income contexts that nurses value practice environments that ensure enough staff to provide adequate patient care [ 23 ]; a broad consensus on the relationship between job demands (such as workload, time pressure and staffing levels) and burnout, particularly emotional exhaustion [ 24 , 25 ]; and a positive, significant association between high-nurse patient ratios and burnout [ 26 ]. The limited evidence from sub-Saharan Africa shows the negative effect of staffing levels and workload on nursing cadres, predicting outcomes such as burnout [ 27 ], while research in Malawi has indicated that staff perceptions of insufficient staff or time to carry out their work can predict key variables concerning motivation and attrition [ 28 ], as well as resulting in sub-standard care and poor attitudes towards women [ 29 ]. These factors drive a vicious cycle where the lack of an enabling environment leads to poor quality clinical care and disrespect, which in turn dissuade women from facility-based delivery, encourage them to bypass facilities with a bad reputation, or to delay seeking care and then arrive in critical condition [ 16 , 21 , 30 , 31 ].…”

Unregulated usage of labour-inducing medication in a region of Pakistan with poor drug regulatory control: characteristics and risk patterns

“…Additionally, as the study was facility-based, such cases may have been selectively missed: since postpartum haemorrhage results in sudden, copious amounts of blood loss as well as rapid death, most patients possibly cannot reach a health facility, as most births are in rural areas in Pakistan and similar countries. 26 – 28 …”