Bazirete Oliva, Nzayirambaho Manassé, Umubyeyi Aline, Uwimana Marie Chantal, Evans Marilyn
College of Medicine and Health Sciences, University of Rwanda, 3286, Kigali, Rwanda.
University of Western Ontario, Arthur Labatt Family School of Nursing, 1151 Richmond St, London, ON, N6A 3K7, Canada.
BMC Pregnancy Childbirth. 2020 Nov 10;20(1):678. doi: 10.1186/s12884-020-03389-7.
Reduction of maternal mortality and morbidity is a major global health priority. However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for prevention of PPH and early detection of childbearing women at risk as perceived by beneficiaries and health workers in the Northern Province of Rwanda.
A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed methods study. Semi-structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women's partners or close relatives (2 focus groups), community health workers (CHWs) in charge of maternal health (2 focus groups) and health care providers (3 focus groups). A socio ecological model was used to develop interview guides describing factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board.
We generated four interrelated themes: (1) Meaning of PPH: beliefs, knowledge and understanding of PPH: (2) Organizational factors; (3) Caring and family involvement and (4) Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH.
Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. Involvement of all levels of the health system was recommended for a proactive prevention of PPH. Further quantitative research, using case control design is warranted to develop a screening tool for early detection of PPH risk factors for a proactive prevention.
降低孕产妇死亡率和发病率是全球主要的卫生优先事项。然而，在卢旺达，关于育龄妇女产后出血（PPH）相关因素仍有许多未知之处。本研究的目的是探讨卢旺达北部省份的受益人和卫生工作者所认为的预防PPH及早期发现高危育龄妇女的影响因素。
本定性描述性探索性研究取自一项更大规模的序贯探索性混合方法研究。对11名在访谈前6个月内经历过PPH的妇女进行了半结构化访谈。此外，还与以下人员进行了焦点小组讨论：女性伴侣或近亲（2个焦点小组）、负责孕产妇健康的社区卫生工作者（CHWs，2个焦点小组）和医疗服务提供者（3个焦点小组）。采用社会生态模型制定访谈指南，考虑个体属性、人际、家庭和同伴影响、健康的中间决定因素和结构决定因素，描述与PPH早期发现和预防相关的因素。该研究方案已获得卢旺达大学医学院和健康科学学院机构伦理审查委员会的批准。
我们得出了四个相互关联的主题：（1）PPH的含义：对PPH的信念、知识和理解；（2）组织因素；（3）关爱与家庭参与；（4）感知到的PPH预防风险因素和障碍。本研究结果表明，妇女及其伴侣对PPH了解甚少。家庭成员和社区卫生工作者认为他们预防PPH的作用是及时将妇女送往医疗机构。参与者描述的与PPH相关的主要因素是多胎妊娠和胎盘滞留。低社会经济地位和获得医疗服务的延迟被确定为预防PPH的主要障碍。
解决已确定的因素可以加强对育龄妇女PPH的早期预防。强调制定针对PPH高危妇女早期发现的策略、医疗服务提供者的持续专业发展、为社区卫生工作者和家庭成员编写教育材料，可以改善PPH的预防。建议卫生系统各级参与，积极预防PPH。有必要进行进一步的定量研究，采用病例对照设计，以开发一种筛查工具，用于早期发现PPH风险因素，进行积极预防。
