Meeting demand-Obstetric hemorrhage and blood availability in Malawi, a qualitative study

Stephen E Njolomole; Ridhaa Fatima Sachidanandan; George Mandere; Alisa Jenny; Adamson S Muula; Bridon M'baya; Ben Malinga John; Luis Gadama; Phylos Bonongwe; Sylvester Chabunya; Evance Storey; Dilys Walker

doi:10.1371/journal.pone.0273426

Meeting demand-Obstetric hemorrhage and blood availability in Malawi, a qualitative study

PLoS One. 2022 Aug 24;17(8):e0273426. doi: 10.1371/journal.pone.0273426. eCollection 2022.

Authors

Stephen E Njolomole^{1

2}, Ridhaa Fatima Sachidanandan³, George Mandere⁴, Alisa Jenny⁵, Adamson S Muula⁶, Bridon M'baya⁷, Ben Malinga John⁴, Luis Gadama⁸, Phylos Bonongwe^{9

10}, Sylvester Chabunya¹, Evance Storey^{10

11}, Dilys Walker¹²

Affiliations

¹ Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
² Transfusion Sciences Initiative, Blantyre, Malawi.
³ School of Medicine, University of California, San Francisco, California, United States of America.
⁴ Department of Population Studies, University of Malawi, Zomba, Malawi.
⁵ Institute for Global Health Sciences, University of California, San Francisco, California, United States of America.
⁶ Department of Community and Environmental health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
⁷ Malawi Blood Transfusion Service, Blantyre, Malawi.
⁸ Department of Obstetrics and Gynaecology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
⁹ Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi.
¹⁰ Ministry of Health, Malawi Government, Lilongwe, Malawi.
¹¹ Laboratory Department, Queen Elizabeth Central Hospital, Blantyre, Malawi.
¹² Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, United States of America.

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.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Blood Transfusion
Female
Humans
Malawi
Maternal Mortality
Postpartum Hemorrhage* / etiology
Pregnancy
Qualitative Research

Grants and funding

This research was funded by the United States Agency for International Development (USAID) under the Health Evaluation and Applied Research Development (HEARD), Cooperative Agreement No. AID-OAA-A-17-00002. HEARD provided funds to S.E.N. through this award. This study is made possible by the support of the American People through the United States Agency for International Development (USAID). The findings of this study are the sole responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of manuscript. https://urldefense.com/v3/__https://www.heardproject.org/__;!!LQC6Cpwp!s0k-oBnE6fhfnKFSEb1eOrMVvRebFI4WaHSAJTRKhcofDLgykxg_vk2-i8CUVDyX_7zjqw5GyQsGNBwtPbnEg7KZ1g$.