Meeting demand—Obstetric hemorrhage and blood availability in Malawi, a qualitative study
Background Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malawi. Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to success...
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| Veröffentlicht in: | PloS one 2022-08, Vol.17 (8), p.e0273426-e0273426 |
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| creator | Njolomole, Stephen E Sachidanandan, Ridhaa Fatima Mandere, George Jenny, Alisa Muula, Adamson S M'baya, Bridon John, Ben Malinga Gadama, Luis Bonongwe, Phylos Chabunya, Sylvester Storey, Evance Walker, Dilys |
| description | Background Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malawi. Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to successful PPH management. This study aims to understand the factors that affect the blood delivery pipeline and adequate access to blood products for postpartum haemorrhage patients. Methods Qualitative data were collected through in-depth interviews with key stakeholders across the blood delivery pipeline. Interviews were conducted from July 2020 to January 2021 at Queen Elizabeth Central Hospital and Mulanje District Hospital, a referral and district hospital respectively, as well as the Malawi Blood Transfusion Service. Line by line, open coding was used to perform a thematic analysis of the data using Nvivo and Atlas.ti software. Results Five key themes were identified: 1) Lack of blood availability due to an inadequate donor pool, 2) Transportation of blood products and PPH patients is impeded by distance to target sites and competing interests for blood delivery vehicles, 3) The Malawi Blood Transfusion Service has difficulty meeting demand for blood products due to inadequate funding and difficulty retaining blood donors, 4) Current PPH management protocols and practices lead to delays due to inconsistent guidelines on delivery and analysis of patient samples, and 5) Communication between health cadres is inconsistent and affected by a lack of adequate resources. Conclusions Barriers to timely blood transfusion for PPH patients exist across the blood delivery pipeline. While an investment of infrastructure would alleviate many obstacles, several solutions identified in this study can be implemented without additional resources, such as establishing joint department meetings to improve communication between health cadres. Ultimately, given a resource limited setting, it may be worth considering de-centralizing the blood supply. |
| doi_str_mv | 10.1371/journal.pone.0273426 |
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Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to successful PPH management. This study aims to understand the factors that affect the blood delivery pipeline and adequate access to blood products for postpartum haemorrhage patients. Methods Qualitative data were collected through in-depth interviews with key stakeholders across the blood delivery pipeline. Interviews were conducted from July 2020 to January 2021 at Queen Elizabeth Central Hospital and Mulanje District Hospital, a referral and district hospital respectively, as well as the Malawi Blood Transfusion Service. Line by line, open coding was used to perform a thematic analysis of the data using Nvivo and Atlas.ti software. Results Five key themes were identified: 1) Lack of blood availability due to an inadequate donor pool, 2) Transportation of blood products and PPH patients is impeded by distance to target sites and competing interests for blood delivery vehicles, 3) The Malawi Blood Transfusion Service has difficulty meeting demand for blood products due to inadequate funding and difficulty retaining blood donors, 4) Current PPH management protocols and practices lead to delays due to inconsistent guidelines on delivery and analysis of patient samples, and 5) Communication between health cadres is inconsistent and affected by a lack of adequate resources. Conclusions Barriers to timely blood transfusion for PPH patients exist across the blood delivery pipeline. While an investment of infrastructure would alleviate many obstacles, several solutions identified in this study can be implemented without additional resources, such as establishing joint department meetings to improve communication between health cadres. Ultimately, given a resource limited setting, it may be worth considering de-centralizing the blood supply.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0273426</identifier><identifier>PMID: 36001581</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Availability ; Biology and Life Sciences ; Births ; Blood ; Blood & organ donations ; Blood donors ; Blood products ; Blood transfusion ; Blood transfusions ; Care and treatment ; Complications and side effects ; Data collection ; Engineering and Technology ; Health aspects ; Health sciences ; Hemorrhage ; Hospitals ; Maternal mortality ; Medical schools ; Medicine ; Medicine and Health Sciences ; Mothers ; Obstetrics ; Patient outcomes ; Patients ; People and Places ; Postpartum ; Pregnant women ; Qualitative analysis ; Qualitative research ; Transfusion</subject><ispartof>PloS one, 2022-08, Vol.17 (8), p.e0273426-e0273426</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Njolomole et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Njolomole et al 2022 Njolomole et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c669t-c2bc74c0d41432ba4b2e13bedd99c93ce59a35c4b2dd5a0bc8ffe338fd5568ba3</citedby><cites>FETCH-LOGICAL-c669t-c2bc74c0d41432ba4b2e13bedd99c93ce59a35c4b2dd5a0bc8ffe338fd5568ba3</cites><orcidid>0000-0001-5678-3794</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9401179/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9401179/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23847,27903,27904,53769,53771,79346,79347</link.rule.ids></links><search><contributor>Mordaunt, Dylan A</contributor><creatorcontrib>Njolomole, Stephen E</creatorcontrib><creatorcontrib>Sachidanandan, Ridhaa Fatima</creatorcontrib><creatorcontrib>Mandere, George</creatorcontrib><creatorcontrib>Jenny, Alisa</creatorcontrib><creatorcontrib>Muula, Adamson S</creatorcontrib><creatorcontrib>M'baya, Bridon</creatorcontrib><creatorcontrib>John, Ben Malinga</creatorcontrib><creatorcontrib>Gadama, Luis</creatorcontrib><creatorcontrib>Bonongwe, Phylos</creatorcontrib><creatorcontrib>Chabunya, Sylvester</creatorcontrib><creatorcontrib>Storey, Evance</creatorcontrib><creatorcontrib>Walker, Dilys</creatorcontrib><title>Meeting demand—Obstetric hemorrhage and blood availability in Malawi, a qualitative study</title><title>PloS one</title><description>Background Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malawi. Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to successful PPH management. This study aims to understand the factors that affect the blood delivery pipeline and adequate access to blood products for postpartum haemorrhage patients. Methods Qualitative data were collected through in-depth interviews with key stakeholders across the blood delivery pipeline. Interviews were conducted from July 2020 to January 2021 at Queen Elizabeth Central Hospital and Mulanje District Hospital, a referral and district hospital respectively, as well as the Malawi Blood Transfusion Service. Line by line, open coding was used to perform a thematic analysis of the data using Nvivo and Atlas.ti software. Results Five key themes were identified: 1) Lack of blood availability due to an inadequate donor pool, 2) Transportation of blood products and PPH patients is impeded by distance to target sites and competing interests for blood delivery vehicles, 3) The Malawi Blood Transfusion Service has difficulty meeting demand for blood products due to inadequate funding and difficulty retaining blood donors, 4) Current PPH management protocols and practices lead to delays due to inconsistent guidelines on delivery and analysis of patient samples, and 5) Communication between health cadres is inconsistent and affected by a lack of adequate resources. Conclusions Barriers to timely blood transfusion for PPH patients exist across the blood delivery pipeline. While an investment of infrastructure would alleviate many obstacles, several solutions identified in this study can be implemented without additional resources, such as establishing joint department meetings to improve communication between health cadres. Ultimately, given a resource limited setting, it may be worth considering de-centralizing the blood supply.</description><subject>Availability</subject><subject>Biology and Life Sciences</subject><subject>Births</subject><subject>Blood</subject><subject>Blood & organ donations</subject><subject>Blood donors</subject><subject>Blood products</subject><subject>Blood transfusion</subject><subject>Blood transfusions</subject><subject>Care and treatment</subject><subject>Complications and side effects</subject><subject>Data collection</subject><subject>Engineering and Technology</subject><subject>Health aspects</subject><subject>Health sciences</subject><subject>Hemorrhage</subject><subject>Hospitals</subject><subject>Maternal mortality</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Mothers</subject><subject>Obstetrics</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>People and 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demand—Obstetric hemorrhage and blood availability in Malawi, a qualitative study</title><author>Njolomole, Stephen E ; Sachidanandan, Ridhaa Fatima ; Mandere, George ; Jenny, Alisa ; Muula, Adamson S ; M'baya, Bridon ; John, Ben Malinga ; Gadama, Luis ; Bonongwe, Phylos ; Chabunya, Sylvester ; Storey, Evance ; Walker, Dilys</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c669t-c2bc74c0d41432ba4b2e13bedd99c93ce59a35c4b2dd5a0bc8ffe338fd5568ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Availability</topic><topic>Biology and Life Sciences</topic><topic>Births</topic><topic>Blood</topic><topic>Blood & organ donations</topic><topic>Blood donors</topic><topic>Blood products</topic><topic>Blood transfusion</topic><topic>Blood transfusions</topic><topic>Care and treatment</topic><topic>Complications and side effects</topic><topic>Data collection</topic><topic>Engineering and Technology</topic><topic>Health aspects</topic><topic>Health sciences</topic><topic>Hemorrhage</topic><topic>Hospitals</topic><topic>Maternal mortality</topic><topic>Medical schools</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Mothers</topic><topic>Obstetrics</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>People and Places</topic><topic>Postpartum</topic><topic>Pregnant women</topic><topic>Qualitative analysis</topic><topic>Qualitative research</topic><topic>Transfusion</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Njolomole, Stephen E</creatorcontrib><creatorcontrib>Sachidanandan, Ridhaa Fatima</creatorcontrib><creatorcontrib>Mandere, George</creatorcontrib><creatorcontrib>Jenny, Alisa</creatorcontrib><creatorcontrib>Muula, Adamson S</creatorcontrib><creatorcontrib>M'baya, Bridon</creatorcontrib><creatorcontrib>John, Ben Malinga</creatorcontrib><creatorcontrib>Gadama, 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Phylos</au><au>Chabunya, Sylvester</au><au>Storey, Evance</au><au>Walker, Dilys</au><au>Mordaunt, Dylan A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meeting demand—Obstetric hemorrhage and blood availability in Malawi, a qualitative study</atitle><jtitle>PloS one</jtitle><date>2022-08-24</date><risdate>2022</risdate><volume>17</volume><issue>8</issue><spage>e0273426</spage><epage>e0273426</epage><pages>e0273426-e0273426</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Background Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malawi. Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to successful PPH management. This study aims to understand the factors that affect the blood delivery pipeline and adequate access to blood products for postpartum haemorrhage patients. Methods Qualitative data were collected through in-depth interviews with key stakeholders across the blood delivery pipeline. Interviews were conducted from July 2020 to January 2021 at Queen Elizabeth Central Hospital and Mulanje District Hospital, a referral and district hospital respectively, as well as the Malawi Blood Transfusion Service. Line by line, open coding was used to perform a thematic analysis of the data using Nvivo and Atlas.ti software. Results Five key themes were identified: 1) Lack of blood availability due to an inadequate donor pool, 2) Transportation of blood products and PPH patients is impeded by distance to target sites and competing interests for blood delivery vehicles, 3) The Malawi Blood Transfusion Service has difficulty meeting demand for blood products due to inadequate funding and difficulty retaining blood donors, 4) Current PPH management protocols and practices lead to delays due to inconsistent guidelines on delivery and analysis of patient samples, and 5) Communication between health cadres is inconsistent and affected by a lack of adequate resources. Conclusions Barriers to timely blood transfusion for PPH patients exist across the blood delivery pipeline. While an investment of infrastructure would alleviate many obstacles, several solutions identified in this study can be implemented without additional resources, such as establishing joint department meetings to improve communication between health cadres. Ultimately, given a resource limited setting, it may be worth considering de-centralizing the blood supply.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>36001581</pmid><doi>10.1371/journal.pone.0273426</doi><tpages>e0273426</tpages><orcidid>https://orcid.org/0000-0001-5678-3794</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2022-08, Vol.17 (8), p.e0273426-e0273426 |
| issn | 1932-6203 1932-6203 |
| language | eng |
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| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Availability Biology and Life Sciences Births Blood Blood & organ donations Blood donors Blood products Blood transfusion Blood transfusions Care and treatment Complications and side effects Data collection Engineering and Technology Health aspects Health sciences Hemorrhage Hospitals Maternal mortality Medical schools Medicine Medicine and Health Sciences Mothers Obstetrics Patient outcomes Patients People and Places Postpartum Pregnant women Qualitative analysis Qualitative research Transfusion |
| title | Meeting demand—Obstetric hemorrhage and blood availability in Malawi, a qualitative study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T00%3A46%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Meeting%20demand%E2%80%94Obstetric%20hemorrhage%20and%20blood%20availability%20in%20Malawi,%20a%20qualitative%20study&rft.jtitle=PloS%20one&rft.au=Njolomole,%20Stephen%20E&rft.date=2022-08-24&rft.volume=17&rft.issue=8&rft.spage=e0273426&rft.epage=e0273426&rft.pages=e0273426-e0273426&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0273426&rft_dat=%3Cgale_plos_%3EA714882611%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2706145208&rft_id=info:pmid/36001581&rft_galeid=A714882611&rft_doaj_id=oai_doaj_org_article_2a8170f85f5a462eacf218bfbc4c9478&rfr_iscdi=true |