Abstract:
Postpartum haemorrhage is associated with significant maternal morbidity, long term disability and mortality in the world today. Whereas the world health organization has recorded a global decline in the overall incidence of maternal mortality due to postpartum haemorrhage, empirical studies postulate a downward trend only in developed countries. On contrary, postpartum haemorrhage is still a major concern in low-income countries accounting for 26% of all maternal globally. In Sub-Saharan Africa, postpartum haemorrhage accounts for 10.5% while in Kenya 13.5% of all maternal deaths. Anecdotal literature gotten from patient records posits that Thika Level 5 Hospital reports approximately 30 postpartum haemorrhage cases in a month. This study sought to assess the determinants of postpartum haemorrhage among women of reproductive age at Thika level 5 hospital. The study adopted an unmatched case control study applying mixed methods that combined quantitative and qualitative techniques. The study population were women of reproductive age who had delivered at Thika Level 5 hospital and had or did not have postpartum haemorrhage within 24 hours. Key informants targeted for qualitative were nurse in charge, and the deputy nurses in charge. A sample size of 76 respondents (19 cases and 57 controls) was picked through use of simple random sampling technique while key informants were selected using purposive sampling. Qualitative data was collected through use of a key interview guide and quantitative data by use of a semi-structured questionnaire. Data was analysed using binary logistic regression. The key findings indicate that, having previous experience with postpartum haemorrhage was significantly associated with postpartum haemorrhage. Where, it was established that respondents who experienced postpartum haemorrhage in the previous pregnancy were 14.04 times more likely to have postpartum haemorrhage than their counterparts (OR = 14.04; 95% CI [2.40 – 82.20]; P=<0.001). Qualitative results revealed that shortage of resources, guidelines for management of postpartum haemorrhage, training of health workers on postpartum haemorrhage were hospital-based factors reported to relate to postpartum haemorrhage. Therefore there is need for hospital management to reconsider ways and strategies of preventing postpartum haemorrhage among women. The respective government should ensure that antenatal clinics institute expert screening for women with prior postpartum haemorrhage occurrence. Increased deployment of midwives to maternity wards should help ease the workload burden and enhance response to risks and emergencies related to postpartum haemorrhage.
