DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20196044

Healthcare workers’ knowledge and attitude towards prompt referral of women with postpartum haemorrhage in Nigeria: a community-based study

Adekemi Eunice Olowokere, Aanuoluwapo Omobolanle Olajubu, Ifeoluwa Eunice Ayeni, Olayinka Olaitan Aremu

Abstract


Background: Postpartum Haemorrhage (PPH) is a major contributor to maternal mortality in developing countries most especially in the rural areas where Emergency Obstetric Care (EmOC) are not available. Delay in referring women from rural health facilities to settings where EmOC services are available have been reported. This study assessed community-based healthcare workers’ (CHWs) knowledge and attitude towards the prevention, early recognition and prompt referral of women with Post-Partum Haemorrhage (PPH) for Emergency Obstetric Care (EmOC).

Methods: Descriptive cross-sectional design was used. Structured questionnaire was used to collect data from 200 CHWs recruited from community-based healthcare. Data analysis was done in SPSS version 20 at significance level of 0.05.

Results: Findings show that 86.5% (n=173) of the respondents had good knowledge while 12% (n=24) and 1.5% (n=3) had moderate and poor knowledge respectively. Negative attitude towards prompt referral of women affected with PPH was found among 51% (n=102) of the respondents. Unavailability of blood drapes to estimate blood loss [χ2 (1, n=200) = 4.51, p=0.03], lack of ambulance [χ2 (1, n=200) = 4.46, p=0.03], and poor state of the roads [χ2 (1, n=200) = 4.44, p=0.03] were factors linked to poor attitude of CHWs towards prompt referral of affected women.

Conclusions: The study concluded that there is a need for intervention that can help improve community healthcare workers’ attitude towards prompt referral of women affected with postpartum haemorrhage. There is also a need for general overhaul of community-based facilities to effectively support prompt referral.


Keywords


Attitude towards referral, Community-based healthcare workers, Early recognition of postpartum haemorrhage, Emergency obstetric care, Knowledge of postpartum haemorrhage, Maternal mortality

Full Text:

PDF

References


World Health Organization. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization, 2015. Available at: http://www.afro.who.int/sites/default/files/2017-05/trends-in-maternal-mortality-1990-to-2015.pdf. Accessed 25 July 2017.

World Health Organization. WHO Recommendation for the prevention and treatment of Postpartum Haemorrhage. WHO Press, 2012. Available at: http://www.who.int/ins/bitscreen/10665/75411/1/9789241548502_eng.pdf. Accessed 5 July 2016.

Tort J, Rozenberg P, Traoré M, Fournier P, Dumont A. Factors associated with postpartum haemorrhage maternal death in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey. BMC Preg Childbirth. 2015;15:235.

Smith JR. Postpartum haemorrhage. Medscape. Available at: https://emedicine.medscape. com/article/27503-overview. Accessed 13 December 2017.

World Health Organization. Reducing the global burden: Post-partum Haemorrhage. Making pregnancy safer; WHO 2007. Available at: http://www.who.int/maternal_child_adolescent/documents/newsletter/mps_newsletter_issue4.pdf. Accessed 7 July 2016.

Sentilhes L, Vayssiere C, Deneuy-Tharaux C, Sentilhes L, Vayssière C, Deneux-Tharaux C, et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eu J Obstet Gynecol Repro Biol. 2016;198:12-2.

Bartlett L, Cantor D, Lynam P, Kaur G, Rawlins B, Ricca J, et al. Facility-based active management of the third stage of labour: assessment of quality in six countries in sub-Saharan Africa. Bullet World Health Organization. 2015;93:759-67.

Abodunrin OL, Akande TM, Osagbemi GK. Awareness and perception toward referral in health care: a study of adult residents in Ilorin, Nigeria. Anna African Med. 2010;9(3):176-80.

Singh AS, Masuku MB. Sampling techniques and determination of sample size in applied statistics research: an overview. Int J Econ Comm Manag. 2014;2(11);1-22.

Ebuehi OM, Chinda GN, Sotund, OM, Oyetoyan SA. Emergency obstetric care: urban versus rural comparison of health workers’ knowledge, attitude and practice in river state, Nigeria- implications for maternal health care in Rivers State. Clin Med Diag. 2013;3(2):29-51.

Kilpatrick SJ, Prentice P, Jones RL, Geller S. Reducing maternal deaths through state maternal mortality review. J Women’s Health. 2012;21(9):905-9.

Della TM, Kilpatrick SJ, Hibbard JU, Simonson L, Scott, Koch A, Geller SE. Assessing preventability for obstetric hemorrhage. Am J Perinatol. 2011;28(10):753-60.

National Primary Health Care Development Agency (NPHCDA). Minimum Standards for Primary Health Care in Nigeria. NPHCDA, 2015. Available at: http://www.nphcda.gov.ng/Reports%20and%20Publications/Minimum%20Standards%20for%20Primary%20Health%20Care%20in%20Nigeria.pdf. Accessed 24 October 2016.

Darkwa EK, Newman MS, Kawkab M, Chowdhury ME. A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh. BMC Health Services Res. 2015;15:344.

Faiza AN. Knowledge and practice of nurse-midwives regarding management and prevention of postpartum haemorrhage in the selected teaching hospitals, Khartoum State-Sudan. Indian J Appl Res. 2014;5(4):634-8.

Jaber EA, Abbas, IM. Assessment of licensed indigenous midwives’ knowledge concerning prevention and management of postpartum hemorrhage in Baghdad city. Iraqi Nat J Nurs Special. 2011;24(2):1-12.

Pathfinder International. Clinical and community action to address postpartum hemorrhage (CCC-PPH) Tool Kit. Pathfinder 2006. Available at: https://www.k4health.org/sites/default/files/Clinical-and-Community-Action-to-Address-Postpartum-Hemorrhage-Table-of-Contents.pdf. Accessed 14 May 2018.

Nshimirimana DE, Mwaura-Tenambergen W, Kokonya D, Adoyo M. Attitudes of primary health care (PHC) gatekeepers towards patient referral policy, Machakos County, Kenya. Sci J Pub Health. 2016;l4(4):284-8.

World Health Organization, 2003. Essential antenatal, perinatal and postpartum care training modules. WHO Regional Office for Europe, 2003. Available at: http://www.euro.who.int/__ data/assets/pdf_file/0013/131521/E79235.pdf. Accessed 31 October 2016.

Martins HE, de Souza MD, Khanum S, Naz N, Souza AC. The practice of nursing in the prevention and control of postpartum hemorrhage: an integrative review. Am J Nur. 2016;5(1):8-15.

Andreatta P, Debpuur D, Danquah A, Perosky J. Using cell phones to collect postpartum hemorrhage outcome data in rural Ghana. Int J Gynecol Obstet. 2011;113(2):148-51.