{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:43:07Z","timestamp":1790602987056,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV\u2010001393"],"award-info":[{"award-number":["INV\u2010001393"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the frequency and timing of postpartum haemorrhage (PPH) treatment initiation between hospitals implementing the MOTIVE treatment bundle (which consisted of uterine Massage, Oxytocic drugs, Tranexamic acid, IntraVenous fluids and Examination) and those following usual care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Nested prospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Hospitals in Nigeria, Kenya, Tanzania and South Africa participating in the E\u2010MOTIVE trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population or Sample<\/jats:title>\n                    <jats:p>Healthcare workers treating PPH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between June and December 2022, we observed healthcare workers for 1\u20132\u2009weeks in 39 E\u2010MOTIVE and 39 usual care hospitals across Nigeria, Kenya, Tanzania, and South Africa managing vaginal birth and treating PPH. We descriptively compared the frequency and timing from PPH detection to treatment initiation of individual treatments and the MOTIVE bundle, between E\u2010MOTIVE care and usual care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2578 observations in E\u2010MOTIVE care hospitals, 295 (11%) PPHs were treated, and among 2834 observations in usual care hospitals, 219 (8%) PPHs were treated. In E\u2010MOTIVE care hospitals, 97% (286\/295) of women with PPH received the MOTIVE bundle, compared to 36% (79\/219) in usual care. Median initiation times for the first component were similar (0 vs. 1\u2009min), but E\u2010MOTIVE care hospitals achieved faster initiation of all components (13\u2009min, IQR 6\u201318) compared to usual care (18\u2009min, IQR 10\u201325). In total, 79% (233\/295) of women in E\u2010MOTIVE care had all components initiated within 20\u2009min, compared to 22% (48\/219) in usual care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Timely and comprehensive management of PPH using the MOTIVE bundle, particularly initiating all components within 15\u201320\u2009min, was commonly observed in the E\u2010MOTIVE care hospitals. Scaling up E\u2010MOTIVE care should emphasise timely bundle initiation to strengthen PPH treatment and improve maternal health outcomes in low\u2010and\u2010middle\u2010income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.18293","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T08:29:02Z","timestamp":1754296142000},"page":"1664-1672","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["When Is Postpartum Haemorrhage Treatment Initiated? A Nested Observational Study Within the E\u2010MOTIVE Trial"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3614-7453","authenticated-orcid":false,"given":"Kristie\u2010Marie","family":"Mammoliti","sequence":"first","affiliation":[{"name":"College of Medicine and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7024-8701","authenticated-orcid":false,"given":"Fernando","family":"Althabe","sequence":"additional","affiliation":[{"name":"UNDP\u2010UNFPA\u2010UNICEF\u2010WHO\u2010World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research World Health Organization  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7028-1421","authenticated-orcid":false,"given":"Christina","family":"Easter","sequence":"additional","affiliation":[{"name":"College of Medicine and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Devall","sequence":"additional","affiliation":[{"name":"College of Medicine and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6949-4200","authenticated-orcid":false,"given":"James","family":"Martin","sequence":"additional","affiliation":[{"name":"College of Medicine and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeosun Love","family":"Funmi","sequence":"additional","affiliation":[{"name":"African Center of Excellence for Population Health and Policy, College of Health Sciences Bayero University  Kano Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahmatu","family":"Yusuf","sequence":"additional","affiliation":[{"name":"African Center of Excellence for Population Health and Policy, College of Health Sciences Bayero University  Kano Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Abubakar","sequence":"additional","affiliation":[{"name":"African Center of Excellence for Population Health and Policy, College of Health Sciences Bayero University  Kano Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lolade Christiana","family":"Arigbede","sequence":"additional","affiliation":[{"name":"African Center of Excellence for Population Health and Policy, College of Health Sciences Bayero University  Kano Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JimKelly","family":"Mugambi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Nairobi  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polycarp","family":"Oyoo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Nairobi  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masumbuko","family":"Sambusa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akwinata","family":"Banda","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fawzia","family":"Samuels","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Willemse","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibongile Doris","family":"Khambule","sequence":"additional","affiliation":[{"name":"Effective Care Research Unit University of the Witwatersrand  Johannesburg South Africa"},{"name":"Walter Sisulu University  Mthatha South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilal Mukhtar","family":"Shu'aib","sequence":"additional","affiliation":[{"name":"African Center of Excellence for Population Health and Policy, College of Health Sciences Bayero University  Kano Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aminu Ado","family":"Wakili","sequence":"additional","affiliation":[{"name":"African Center of Excellence for Population Health and Policy, College of Health Sciences Bayero University  Kano Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenipher","family":"Okore","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Nairobi  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ard","family":"Mwampashi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandisa","family":"Singata\u2010Madliki","sequence":"additional","affiliation":[{"name":"Effective Care Research Unit University of the Witwatersrand  Johannesburg South Africa"},{"name":"Walter Sisulu University  Mthatha South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edna","family":"Arends","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elani","family":"Muller","sequence":"additional","affiliation":[{"name":"Effective Care Research Unit University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadiza","family":"Galadanci","sequence":"additional","affiliation":[{"name":"African Center of Excellence for Population Health and Policy, College of Health Sciences Bayero University  Kano Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahida","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Nairobi  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2416-6876","authenticated-orcid":false,"given":"Fadhlun Alwy","family":"Al\u2010Beity","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3080-1007","authenticated-orcid":false,"given":"G. Justus","family":"Hofmeyr","sequence":"additional","affiliation":[{"name":"Effective Care Research Unit University of the Witwatersrand  Johannesburg South Africa"},{"name":"Walter Sisulu University  Mthatha South Africa"},{"name":"Department of Obstetrics and Gynecology University of Botswana  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Fawcus","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Moran","sequence":"additional","affiliation":[{"name":"KwaZulu\u2010Natal Department of Health  Pietermaritzburg South Africa"},{"name":"Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Gwako","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Nairobi  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Osoti","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Nairobi  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Gallos","sequence":"additional","affiliation":[{"name":"UNDP\u2010UNFPA\u2010UNICEF\u2010WHO\u2010World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research World Health Organization  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arri","family":"Coomarasamy","sequence":"additional","affiliation":[{"name":"College of Medicine and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1513247"},{"key":"e_1_2_10_3_1","volume-title":"A Roadmap to Combat Postpartum Haemorrhage Between 2023 and 2030","author":"World Health Organisation","year":"2023"},{"key":"e_1_2_10_4_1","volume-title":"Trends in Maternal Mortality 2000 to 2020: Estimated by WHO, UNICEF, UNFPA, World Bank Group and UNDESA \/Population Division","author":"World Health Organisation","year":"2023"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","unstructured":"I.Yunas I. D.Gallos A. J.Devall et\u00a0al. \u201cTests for Diagnosis of Postpartum Haemorrhage at Vaginal Birth \u201d(2024).","DOI":"10.1002\/14651858.CD016134"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05342-y"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0001670"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15624"},{"key":"e_1_2_10_9_1","volume-title":"WHO Recommendations on the Assessment of Postpartum Blood Loss and Use of a Treatment Bundle for Postpartum Haemorrhage","author":"World Health Organisation","year":"2023"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2303966"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-23-00387"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(24)00454-6"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(25)00302-X","article-title":"When are postpartum haemorrhages detected? A nested observational study within the E\u2010MOTIVE cluster\u2010randomised trial","author":"Mammoliti K.\u2010M.","year":"2025","journal-title":"Lancet Global Health"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.04.013"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.21586\/ross0000004"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-263X.2010.01051.x"},{"issue":"340","key":"e_1_2_10_17_1","first-page":"455","article-title":"Does Awareness of Being Video Recorded Affect Doctors Consultation Behavior","volume":"40","author":"Pringle M.","year":"1990","journal-title":"British Journal of General Practice"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.18293","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1471-0528.18293","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.18293","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T02:37:48Z","timestamp":1769740668000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.18293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":16,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/1471-0528.18293"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.18293","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,4]]},"assertion":[{"value":"2025-03-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}