Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Implementation Science

Background:

• Postpartum haemorrhage (PPH) is a major global cause of maternal mortality.
• The E-MOTIVE trial demonstrated significant reduction in PPH adverse outcomes with a novel intervention.
• A mixed-methods process evaluation was conducted across four African countries.

Purpose of the Study:

• To assess the implementation of the E-MOTIVE intervention in diverse healthcare settings.
• To evaluate fidelity, adoption, adaptation, acceptability, and feasibility of the intervention components.
• To identify barriers and facilitators for successful scale-up of PPH management strategies.

Main Methods:

• Mixed-methods approach combining direct observations, health worker surveys, and qualitative interviews.
• Intervention sites utilized calibrated drapes and the MOTIVE treatment bundle; control sites used standard drapes.
• Data collected on fidelity to calibrated drape use, PPH treatment bundle delivery, and timeliness of care.

Main Results:

• High fidelity (98.3%-100%) observed for calibrated drape use and PPH treatment bundle delivery (96.9%).
• Health workers reported high acceptability and feasibility of the intervention components.
• Moderate to high fidelity in initiating PPH treatment within 15-20 minutes of diagnosis was achieved in 81.5% of cases.

Conclusions:

• The E-MOTIVE intervention demonstrates high fidelity, feasibility, and acceptability in real-world settings.
• Integration into national policies is recommended, with attention to health system strengthening (workforce, supplies, medications).
• Successful implementation requires addressing identified health system constraints for optimal PPH management.