Midwives’ compliance with guidelines for prevention and management of postpartum haemorrhage in Katete district Eastern province, Zambia

Abstract

Postpartum haemorrhage (PPH) has remained top among the causes of maternal mortality in Sub-Saharan Africa, and is the direct cause of 34% of maternal mortalities in Zambia. The World Health Organisation (WHO) provides evidence-based interventions to reduce maternal mortality which focus on prevention, treatment and management of PPH. Despite these interventions, Katete district has kin the past four years registered an average of 55% PPH related mortalities. This study aimed at determining midwives’ compliance to guidelines for prevention and management of PPH in Katete district, Zambia. A cross sectional study design involving 36 midwives from 13 health facilities was utilised for the study. Using multistage sampling, health facilities were stratified into health posts, health centres, zonal health centres and hospitals, followed by purposive sampling to select the particular health facilities. Simple random sampling was used to select midwives in facilities with more than one midwife while convenience sampling was used in facilities with a single midwife. A self-administered questionnaire and an observational checklist were used to collect data, which was analysed using Statistical package for Social Sciences version 23.0. Logistic regression analysis, Chi-square test and Fisher’s Exact test were used to determine the relationship among variables. Eleven out of the 13 health facilities had inadequate resources. Compliance to PPH prevention and management guidelines was poor in 64% of the midwives; 61% of the midwives exhibited high knowledge in PPH prevention and management guidelines, while 66.7% showed poor practices in the management of PPH. Compliance was significantly associated with practices (P-value=0.001) but not with knowledge (p-value=0.968) or availability of resources (P-value=0.464). Compliance was 1.556 times higher among those aged 36-50 years, 1.667 times more likely among female midwives and 1.857 times more likely among Registered Midwives (RMs). Midwives with a shorter length of service (2-5 years) were three times more likely to comply with PPH prevention and management guidelines. Compliance increased 1.8 times among midwives with high knowledge and five times more among midwives with good practices. Midwives from facilities with inadequate resources were 1.778 times more likely to comply to PPH prevention and management guidelines. There were poor practices in the prevention and management of PPH among midwives in Katete District because they were not complying with the guidelines. This was despite their knowledge levels being high. Keywords: Compliance, Guidelines, postpartum haemorrhage, Prevention, Management.