Assessing policy and operational barriers to tranexamic acid utilization in treating postpartum hemorrhage in Kano, Lagos, and Niger states

OBJECTIVE: This study explores the barriers to the use of tranexamic acid (TXA) for the management of postpartum hemorrhage (PPH) and provides recommendations to improve its use. METHODS: We conducted a mixed-methods assessment involving 229 healthcare professionals in Kano, Lagos, and Niger States of Nigeria. The assessment involved the use of semi-structured questionnaires and document analysis. The questionnaire was developed following co-creation workshop with relevant stakeholders where 29 documents relating to TXA effectiveness in treating PPH were reviewed. Insights gained from the quantitative study informed the design of a qualitative study. Key informant interviews were carried out with 20 policymakers, five state procurement staff, two TXA suppliers, two researchers, and one National Agency for Food and Drug Administration and Control (NAFDAC) representative. Thematic analysis was conducted across three key themes: policy, product pathway, and client journey. RESULTS: Findings indicate the absence of updated PPH treatment guidelines endorsing TXA. Only 8% of healthcare workers knew of such policies, with 99% lacking related training. Supply chain challenges, including quantification, procurement, quality, and financing, were observed. Lagos state alone procured TXA among the assessed states. While 9% of healthcare workers recognized TXA's indication for PPH treatment, only 20 reported routine use, mostly by doctors. These findings were further discussed during solution co-creation workshops in the three states to chart plans for increasing TXA use. CONCLUSION: Recommendations towards enhancing TXA utilization include updating national guidelines, expanding in-service training, improving supply mechanisms, and integrating TXA into existing procurement systems. These interventions aim to increase TXA adoption, reduce PPH-related deaths, and improve maternal health.