Healthcare Providers’ Practices in Postpartum Hemorrhage Management: A Multi-Centre Cross-Sectional Study in Tanzania

Catherine Safari Massay,1– 3 Paschal Francis Mdoe,2,3 Benjamin A Kamala,2– 4 Robert Moshiro,5,6 Estomih Mduma,2,3 Sara Rivenes,7 Jørgen Linde,8 Godfrey Guga,2,3 Hege L Ersdal,9,10 Michael Johnson Mahande111Department of Midwifery, School of Nursing, KCMC University, Moshi, Tanzania; 2Department of Obstetrics and Gynaecology, Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania; 3Department of Research, Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania; 4Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania; 5Department of Paediatrics, Muhimbili National Hospital, Dar Es Salaam, Tanzania; 6Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 7Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; 8Department of Obstetrics and Gynaecology, Stavanger University Hospital, Stavanger, Norway; 9Department of Simulation-Based Learning, Stavanger University Hospital, Stavanger, Norway; 10Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 11Department of Epidemiology and Biostatistics, Institute of Public Health, KCMC University, Moshi, TanzaniaCorrespondence: Catherine Safari Massay, Department of Midwifery, School of Nursing, KCMC University, Moshi, Tanzania, Email [email protected]: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality in Tanzania. Accurate diagnosis, proper documentation, and effective patient communication including disclosure and informed consent are essential for quality PPH care. However, evidence on these practices among healthcare providers (HCPs) is limited. This study assessed HCPs practices related to PPH diagnosis, documentation, disclosure and consent in Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) facilities.Methods: A facility-based cross-sectional study was conducted between October and November 2024 among healthcare provider working in maternity ward in 142 CEmONC facilities implementing the Safer Births Bundle of Care across five regions in Tanzania. Healthcare providers providing care to birthing women were voluntarily invited to participate. Convenience sampling was used in recruitment. Data were collected using a structured, pre-tested questionnaire administered using Open Data Kit. Descriptive statistics summarized HCPs characteristics and practices. Chi-square tests was used to assess the associations between practices and HCPs characteristics, with statistical significance set at p < 0.05.Results: A total of 446 HCP participated in the study. Most HCPs 371 (83.2%) received training on PPH diagnosis. Visual estimation of blood loss was the predominant diagnostic method 435 (97.5%). However, only 194 (43.5%) reported good diagnostic practices based on the assessed criteria. Documentation was suboptimal, with only 79 (17.7%) consistently recording all PPH diagnoses, while 234 (52.5%) documented only severe cases requiring blood transfusion. Regarding patient communication, 356 (79.8%) reported consistently disclosing PPH diagnoses, and 295 (66.1%) obtained consent before invasive procedures. Communication practices were significantly associated with cadre (p=0.012) and education level (p=0.034).Conclusion: Despite high levels of reported training, substantial gaps were identified in diagnostic, documentation, and patient communication practices in PPH management. Strengthening objective diagnostic approaches, improving documentation systems and effective communication practices are needed to improve quality of care.Keywords: postpartum hemorrhage, maternal health, diagnosis, documentation, disclosure, an informed consent, Tanzania