{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:47:51Z","timestamp":1790819271990,"version":"4.1.0"},"reference-count":57,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T00:00:00Z","timestamp":1726704000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/T00326X\/"],"award-info":[{"award-number":["MR\/T00326X\/"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine structural and process readiness for postpartum haemorrhage (PPH) care at referral\u2010level facilities in Ghana and Uganda to identify opportunities for strengthening.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Mixed\u2010methods cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Three districts in Ghana and two in Uganda.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population or Sample<\/jats:title><jats:p>Nine hospitals in Ghana and seven in Uganda; all hospitals had theoretical capacity for caesarean section and blood transfusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We deployed a modular quantitative health facility assessment to explore structural readiness (drugs, equipment, staff) complemented by in\u2010depth interviews with maternity health service providers to understand process readiness (knowledge, attitudes, and practices as related to World Health Organization [WHO] guidance on PPH care).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Availability of essential structural components needed to support key PPH processes of care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In both countries, there was generally good structural readiness for PPH care. However, key common gaps included inadequate staffing (especially specialist physicians), and unavailability of blood for transfusion. Interviews highlighted particularly good process readiness in the provision of uterotonics, recognising and responding to retained placenta, and repairing tears. However, there were clear gaps in the utilisation of tranexamic acid and uterine balloon tamponade.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have identified good structural and process readiness across both Ghanaian and Ugandan health facilities to support PPH responses. However, some key missed opportunities\u2014to align with current WHO guidance on providing bundles of interventions for PPH care\u2014could be strengthened with minimal investment but promising impact.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17953","type":"journal-article","created":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T05:00:11Z","timestamp":1726808411000},"page":"433-443","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessment of Structural and Process Readiness for Postpartum Haemorrhage Care in Uganda and Ghana: A Mixed Methods Study"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8718-5110","authenticated-orcid":false,"given":"Tara","family":"Tancred","sequence":"first","affiliation":[{"name":"Department of International Public Health Liverpool School of Tropical Medicine  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1909-337X","authenticated-orcid":false,"given":"Andrew D.","family":"Weeks","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Mubangizi","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Community Practice Mbarara University of Science and Technology  Mbarara Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Nene Dei","sequence":"additional","affiliation":[{"name":"Research, Planning, Monitoring and Evaluation Department National Blood Service Ghana  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Natukunda","sequence":"additional","affiliation":[{"name":"Community Health Department Mbarara University of Science and Technology  Mbarara Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Cobb","sequence":"additional","affiliation":[{"name":"Department of International Public Health Liverpool School of Tropical Medicine  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imelda","family":"Bates","sequence":"additional","affiliation":[{"name":"Department of International Public Health Liverpool School of Tropical Medicine  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Asamoah\u2010Akuoko","sequence":"additional","affiliation":[{"name":"Research, Planning, Monitoring and Evaluation Department National Blood Service Ghana  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Natukunda","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Science Mbarara University of Science and Technology  Mbarara Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"WHO Recommendations on the Assessment of Postpartum Blood Loss and Use of a Treatment Bundle for Postpartum Haemorrhage","author":"World Health Organization","year":"2023"},{"key":"e_1_2_10_3_1","first-page":"e106","article-title":"Prevention and Management of Postpartum Haemorrhage","volume":"124","author":"Mavrides E.","year":"2016","journal-title":"BJOG: An International Journal of Obstetrics and Gynaecology"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2008.08.004"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_10_6_1","volume-title":"UNDESA Population Division. 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