Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation

Autores: Bohren, Meghan A.; Miller, Suellen; Mammoliti, Kristie Marie; Galadanci, Hadiza; Fawcus, Sue; Moran, Neil; Hofmeyr, G Justus; Qureshi, Zahida; Alwy Al Beity, Fadhlun; Forbes, Gillian; Akter, Shahinoor; Osoti, Alfred; Gwako, George; Melo Santos, Thiago; Evans, Cherrie; Wakili, Aminu Ado; Bakari, Maisaratu; Takai, Idris Usman; Umar, Mohammad; Singata-Madliki, Mandisa; Muller, Elani; Mandondo, Sibongile; Okore, Jenipher; Banda, Akwinata; Sambusa, Masumbuko; Sindhu, Kulandaipalayam N.; Beeson, Leanne; Easter, Christina Louise; Devall, Adam; Gülmezoglu, A. Metin; Althabe, Fernando; Oladapo, Olufemi T.; Gallos, Ioannis; Coomarasamy, Arri; Lorencatto, Fabiana
Año de publicación: 2025
Idioma: inglés
Tipo de recurso: artículo
Estado: versión publicada
Descripción: Background: Postpartum haemorrhage is a leading cause of maternal mortality. A multicountry, cluster-randomised trial (E-MOTIVE) demonstrated a 60% reduction in adverse postpartum haemorrhage outcomes. The E-MOTIVE intervention included early postpartum haemorrhage detection using calibrated blood-collection drapes, followed by a postpartum haemorrhage treatment bundle (ie, uterine massage, oxytocics, tranexamic acid, intravenous fluids, examination and escalation [MOTIVE]), supported by implementation strategies. We report a mixed-methods process evaluation assessing the implementation of the E-MOTIVE intervention in Kenya, Nigeria, South Africa, and Tanzania.Methods: In this mixed-methods process evaluation, data sources were observations of health workers providing clinical care to pregnant women and pregnant people during vaginal birth and postpartum haemorrhage at intervention sites, and surveys and qualitative interviews with health workers at intervention and control sites. Intervention sites received the calibrated drapes, MOTIVE bundle, and implementation strategies and control sites used uncalibrated drapes. Primary implementation outcomes included fidelity, adoption, adaptation, acceptability, feasibility, and contamination to the calibrated drape, MOTIVE bundle, and implementation strategies.Findings: Between June 1, 2022, and Jan 31, 2023, 2578 births were observed, 295 pregnant women and people had postpartum haemorrhage, 47 qualitative interviews were done, and 889 surveys were completed. Fidelity to calibrated drape use was high (birth observations 2578 [100%] of 2578; survey 451 [98·3%] of 459). Among health workers, calibrated drape acceptability was high; however, they reported barriers to pregnant women´s and people´s acceptability. Fidelity to postpartum haemorrhage treatment bundle delivery was high (birth observations 286 [96·9%] of 295), with moderate to high fidelity in median time from postpartum haemorrhage diagnosis to final treatment initiation (≤15 min initiation time in 191 [66·8%] of 295 birth observations, 16–20 min in 42 [14·7%] birth observations), and high acceptability and feasibility. Research midwives participated in clinical assessments after birth and bundle delivery in some sites (mixed fidelity).Interpretation: This process evaluation shows generally high levels of fidelity, feasibility, and acceptability of the calibrated drape and treatment bundle across evaluation methods and countries. The E-MOTIVE intervention should be included in national policies, with consideration for health workforce, supplies, and medication issues, which might need addressing for successful implementation.Funding:The Bill and Melinda Gates Foundation and the UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, a co-sponsored programme of WHO.
Fil: Bohren, Meghan A.. Melbourne School Of Population And Global Health; Australia
Fil: Miller, Suellen. University of California; Estados Unidos
Fil: Mammoliti, Kristie Marie. University Of Birmingham; Reino Unido
Fil: Galadanci, Hadiza. Bayero University; Nigeria
Fil: Fawcus, Sue. University of Cape Town; Sudáfrica
Fil: Moran, Neil. University of KwaZulu-Natal; Sudáfrica
Fil: Hofmeyr, G Justus. University of the Witwatersrand; Sudáfrica
Fil: Qureshi, Zahida. University Of Nairobi; Kenia
Fil: Alwy Al Beity, Fadhlun. Muhimbili University Of Health And Allied Sciences; Tanzania
Fil: Forbes, Gillian. University College London; Estados Unidos
Fil: Akter, Shahinoor. La Trobe University; Australia
Fil: Osoti, Alfred. University Of Nairobi; Kenia
Fil: Gwako, George. University Of Nairobi; Kenia
Fil: Melo Santos, Thiago. University of Melbourne; Australia
Fil: Evans, Cherrie. University Johns Hopkins; Estados Unidos
Fil: Wakili, Aminu Ado. Bayero University; Nigeria
Fil: Bakari, Maisaratu. Bayero University; Nigeria
Fil: Takai, Idris Usman. Bayero University; Nigeria
Fil: Umar, Mohammad. General Hospital Katsina; Nigeria
Fil: Singata-Madliki, Mandisa. University of the Witwatersrand; Sudáfrica
Fil: Muller, Elani. University Of Birmingham;
Fil: Mandondo, Sibongile. University Of Birmingham;
Fil: Okore, Jenipher. University of the Witwatersrand; Sudáfrica
Fil: Banda, Akwinata. Muhimbili University Of Health And Allied Sciences; Tanzania
Fil: Sambusa, Masumbuko. Muhimbili University Of Health And Allied Sciences; Tanzania
Fil: Sindhu, Kulandaipalayam N.. University Of Birmingham;
Fil: Beeson, Leanne. University Of Birmingham;
Fil: Easter, Christina Louise. University Of Birmingham;
Fil: Devall, Adam. University Of Birmingham;
Fil: Gülmezoglu, A. Metin. No especifíca;
Fil: Althabe, Fernando. Organizacion Mundial de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; Argentina
Fil: Gallos, Ioannis. Organizacion Mundial de la Salud; Argentina
Fil: Coomarasamy, Arri. University Of Birmingham;
Fil: Lorencatto, Fabiana. University College London; Estados Unidos
Materia: bundle strategy
Postpartum haemorrhage
mixed methods
Nivel de accesibilidad: acceso abierto
Condiciones de uso: https://creativecommons.org/licenses/by/2.5/ar/
Repositorio
Institución: Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador: oai:ri.conicet.gov.ar:11336/291228

Acceder

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network_acronym_str	CONICETDig
repository_id_str	3498
network_name_str	CONICET Digital (CONICET)
spelling	Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluationBohren, Meghan A.Miller, SuellenMammoliti, Kristie MarieGaladanci, HadizaFawcus, SueMoran, NeilHofmeyr, G JustusQureshi, ZahidaAlwy Al Beity, FadhlunForbes, GillianAkter, ShahinoorOsoti, AlfredGwako, GeorgeMelo Santos, ThiagoEvans, CherrieWakili, Aminu AdoBakari, MaisaratuTakai, Idris UsmanUmar, MohammadSingata-Madliki, MandisaMuller, ElaniMandondo, SibongileOkore, JenipherBanda, AkwinataSambusa, MasumbukoSindhu, Kulandaipalayam N.Beeson, LeanneEaster, Christina LouiseDevall, AdamGülmezoglu, A. MetinAlthabe, FernandoOladapo, Olufemi T.Gallos, IoannisCoomarasamy, ArriLorencatto, Fabianabundle strategyPostpartum haemorrhagemixed methodshttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: Postpartum haemorrhage is a leading cause of maternal mortality. A multicountry, cluster-randomised trial (E-MOTIVE) demonstrated a 60% reduction in adverse postpartum haemorrhage outcomes. The E-MOTIVE intervention included early postpartum haemorrhage detection using calibrated blood-collection drapes, followed by a postpartum haemorrhage treatment bundle (ie, uterine massage, oxytocics, tranexamic acid, intravenous fluids, examination and escalation [MOTIVE]), supported by implementation strategies. We report a mixed-methods process evaluation assessing the implementation of the E-MOTIVE intervention in Kenya, Nigeria, South Africa, and Tanzania.Methods: In this mixed-methods process evaluation, data sources were observations of health workers providing clinical care to pregnant women and pregnant people during vaginal birth and postpartum haemorrhage at intervention sites, and surveys and qualitative interviews with health workers at intervention and control sites. Intervention sites received the calibrated drapes, MOTIVE bundle, and implementation strategies and control sites used uncalibrated drapes. Primary implementation outcomes included fidelity, adoption, adaptation, acceptability, feasibility, and contamination to the calibrated drape, MOTIVE bundle, and implementation strategies.Findings: Between June 1, 2022, and Jan 31, 2023, 2578 births were observed, 295 pregnant women and people had postpartum haemorrhage, 47 qualitative interviews were done, and 889 surveys were completed. Fidelity to calibrated drape use was high (birth observations 2578 [100%] of 2578; survey 451 [98·3%] of 459). Among health workers, calibrated drape acceptability was high; however, they reported barriers to pregnant women´s and people´s acceptability. Fidelity to postpartum haemorrhage treatment bundle delivery was high (birth observations 286 [96·9%] of 295), with moderate to high fidelity in median time from postpartum haemorrhage diagnosis to final treatment initiation (≤15 min initiation time in 191 [66·8%] of 295 birth observations, 16–20 min in 42 [14·7%] birth observations), and high acceptability and feasibility. Research midwives participated in clinical assessments after birth and bundle delivery in some sites (mixed fidelity).Interpretation: This process evaluation shows generally high levels of fidelity, feasibility, and acceptability of the calibrated drape and treatment bundle across evaluation methods and countries. The E-MOTIVE intervention should be included in national policies, with consideration for health workforce, supplies, and medication issues, which might need addressing for successful implementation.Funding:The Bill and Melinda Gates Foundation and the UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, a co-sponsored programme of WHO.Fil: Bohren, Meghan A.. Melbourne School Of Population And Global Health; AustraliaFil: Miller, Suellen. University of California; Estados UnidosFil: Mammoliti, Kristie Marie. University Of Birmingham; Reino UnidoFil: Galadanci, Hadiza. Bayero University; NigeriaFil: Fawcus, Sue. University of Cape Town; SudáfricaFil: Moran, Neil. University of KwaZulu-Natal; SudáfricaFil: Hofmeyr, G Justus. University of the Witwatersrand; SudáfricaFil: Qureshi, Zahida. University Of Nairobi; KeniaFil: Alwy Al Beity, Fadhlun. Muhimbili University Of Health And Allied Sciences; TanzaniaFil: Forbes, Gillian. University College London; Estados UnidosFil: Akter, Shahinoor. La Trobe University; AustraliaFil: Osoti, Alfred. University Of Nairobi; KeniaFil: Gwako, George. University Of Nairobi; KeniaFil: Melo Santos, Thiago. University of Melbourne; AustraliaFil: Evans, Cherrie. University Johns Hopkins; Estados UnidosFil: Wakili, Aminu Ado. Bayero University; NigeriaFil: Bakari, Maisaratu. Bayero University; NigeriaFil: Takai, Idris Usman. Bayero University; NigeriaFil: Umar, Mohammad. General Hospital Katsina; NigeriaFil: Singata-Madliki, Mandisa. University of the Witwatersrand; SudáfricaFil: Muller, Elani. University Of Birmingham;Fil: Mandondo, Sibongile. University Of Birmingham;Fil: Okore, Jenipher. University of the Witwatersrand; SudáfricaFil: Banda, Akwinata. Muhimbili University Of Health And Allied Sciences; TanzaniaFil: Sambusa, Masumbuko. Muhimbili University Of Health And Allied Sciences; TanzaniaFil: Sindhu, Kulandaipalayam N.. University Of Birmingham;Fil: Beeson, Leanne. University Of Birmingham;Fil: Easter, Christina Louise. University Of Birmingham;Fil: Devall, Adam. University Of Birmingham;Fil: Gülmezoglu, A. Metin. No especifíca;Fil: Althabe, Fernando. Organizacion Mundial de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; ArgentinaFil: Gallos, Ioannis. Organizacion Mundial de la Salud; ArgentinaFil: Coomarasamy, Arri. University Of Birmingham;Fil: Lorencatto, Fabiana. University College London; Estados UnidosElsevier Science Inc.2025-02info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/291228Bohren, Meghan A.; Miller, Suellen; Mammoliti, Kristie Marie; Galadanci, Hadiza; Fawcus, Sue; et al.; Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation; Elsevier Science Inc.; The Lancet Global Health; 13; 2; 2-2025; 1-162214-109XCONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://linkinghub.elsevier.com/retrieve/pii/S2214109X24004546info:eu-repo/semantics/altIdentifier/doi/10.1016/S2214-109X(24)00454-6info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-08-25T15:35:46Zoai:ri.conicet.gov.ar:11336/291228instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982026-08-25 15:35:46.803CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv	Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation
title	Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation
spellingShingle	Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation Bohren, Meghan A. bundle strategy Postpartum haemorrhage mixed methods
title_short	Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation
title_full	Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation
title_fullStr	Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation
title_full_unstemmed	Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation
title_sort	Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation
dc.creator.none.fl_str_mv	Bohren, Meghan A. Miller, Suellen Mammoliti, Kristie Marie Galadanci, Hadiza Fawcus, Sue Moran, Neil Hofmeyr, G Justus Qureshi, Zahida Alwy Al Beity, Fadhlun Forbes, Gillian Akter, Shahinoor Osoti, Alfred Gwako, George Melo Santos, Thiago Evans, Cherrie Wakili, Aminu Ado Bakari, Maisaratu Takai, Idris Usman Umar, Mohammad Singata-Madliki, Mandisa Muller, Elani Mandondo, Sibongile Okore, Jenipher Banda, Akwinata Sambusa, Masumbuko Sindhu, Kulandaipalayam N. Beeson, Leanne Easter, Christina Louise Devall, Adam Gülmezoglu, A. Metin Althabe, Fernando Oladapo, Olufemi T. Gallos, Ioannis Coomarasamy, Arri Lorencatto, Fabiana
author	Bohren, Meghan A.
author_facet	Bohren, Meghan A. Miller, Suellen Mammoliti, Kristie Marie Galadanci, Hadiza Fawcus, Sue Moran, Neil Hofmeyr, G Justus Qureshi, Zahida Alwy Al Beity, Fadhlun Forbes, Gillian Akter, Shahinoor Osoti, Alfred Gwako, George Melo Santos, Thiago Evans, Cherrie Wakili, Aminu Ado Bakari, Maisaratu Takai, Idris Usman Umar, Mohammad Singata-Madliki, Mandisa Muller, Elani Mandondo, Sibongile Okore, Jenipher Banda, Akwinata Sambusa, Masumbuko Sindhu, Kulandaipalayam N. Beeson, Leanne Easter, Christina Louise Devall, Adam Gülmezoglu, A. Metin Althabe, Fernando Oladapo, Olufemi T. Gallos, Ioannis Coomarasamy, Arri Lorencatto, Fabiana
author_role	author
author2	Miller, Suellen Mammoliti, Kristie Marie Galadanci, Hadiza Fawcus, Sue Moran, Neil Hofmeyr, G Justus Qureshi, Zahida Alwy Al Beity, Fadhlun Forbes, Gillian Akter, Shahinoor Osoti, Alfred Gwako, George Melo Santos, Thiago Evans, Cherrie Wakili, Aminu Ado Bakari, Maisaratu Takai, Idris Usman Umar, Mohammad Singata-Madliki, Mandisa Muller, Elani Mandondo, Sibongile Okore, Jenipher Banda, Akwinata Sambusa, Masumbuko Sindhu, Kulandaipalayam N. Beeson, Leanne Easter, Christina Louise Devall, Adam Gülmezoglu, A. Metin Althabe, Fernando Oladapo, Olufemi T. Gallos, Ioannis Coomarasamy, Arri Lorencatto, Fabiana
author2_role	author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author
dc.subject.none.fl_str_mv	bundle strategy Postpartum haemorrhage mixed methods
topic	bundle strategy Postpartum haemorrhage mixed methods
purl_subject.fl_str_mv	https://purl.org/becyt/ford/3.3 https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv	Background: Postpartum haemorrhage is a leading cause of maternal mortality. A multicountry, cluster-randomised trial (E-MOTIVE) demonstrated a 60% reduction in adverse postpartum haemorrhage outcomes. The E-MOTIVE intervention included early postpartum haemorrhage detection using calibrated blood-collection drapes, followed by a postpartum haemorrhage treatment bundle (ie, uterine massage, oxytocics, tranexamic acid, intravenous fluids, examination and escalation [MOTIVE]), supported by implementation strategies. We report a mixed-methods process evaluation assessing the implementation of the E-MOTIVE intervention in Kenya, Nigeria, South Africa, and Tanzania.Methods: In this mixed-methods process evaluation, data sources were observations of health workers providing clinical care to pregnant women and pregnant people during vaginal birth and postpartum haemorrhage at intervention sites, and surveys and qualitative interviews with health workers at intervention and control sites. Intervention sites received the calibrated drapes, MOTIVE bundle, and implementation strategies and control sites used uncalibrated drapes. Primary implementation outcomes included fidelity, adoption, adaptation, acceptability, feasibility, and contamination to the calibrated drape, MOTIVE bundle, and implementation strategies.Findings: Between June 1, 2022, and Jan 31, 2023, 2578 births were observed, 295 pregnant women and people had postpartum haemorrhage, 47 qualitative interviews were done, and 889 surveys were completed. Fidelity to calibrated drape use was high (birth observations 2578 [100%] of 2578; survey 451 [98·3%] of 459). Among health workers, calibrated drape acceptability was high; however, they reported barriers to pregnant women´s and people´s acceptability. Fidelity to postpartum haemorrhage treatment bundle delivery was high (birth observations 286 [96·9%] of 295), with moderate to high fidelity in median time from postpartum haemorrhage diagnosis to final treatment initiation (≤15 min initiation time in 191 [66·8%] of 295 birth observations, 16–20 min in 42 [14·7%] birth observations), and high acceptability and feasibility. Research midwives participated in clinical assessments after birth and bundle delivery in some sites (mixed fidelity).Interpretation: This process evaluation shows generally high levels of fidelity, feasibility, and acceptability of the calibrated drape and treatment bundle across evaluation methods and countries. The E-MOTIVE intervention should be included in national policies, with consideration for health workforce, supplies, and medication issues, which might need addressing for successful implementation.Funding:The Bill and Melinda Gates Foundation and the UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, a co-sponsored programme of WHO. Fil: Bohren, Meghan A.. Melbourne School Of Population And Global Health; Australia Fil: Miller, Suellen. University of California; Estados Unidos Fil: Mammoliti, Kristie Marie. University Of Birmingham; Reino Unido Fil: Galadanci, Hadiza. Bayero University; Nigeria Fil: Fawcus, Sue. University of Cape Town; Sudáfrica Fil: Moran, Neil. University of KwaZulu-Natal; Sudáfrica Fil: Hofmeyr, G Justus. University of the Witwatersrand; Sudáfrica Fil: Qureshi, Zahida. University Of Nairobi; Kenia Fil: Alwy Al Beity, Fadhlun. Muhimbili University Of Health And Allied Sciences; Tanzania Fil: Forbes, Gillian. University College London; Estados Unidos Fil: Akter, Shahinoor. La Trobe University; Australia Fil: Osoti, Alfred. University Of Nairobi; Kenia Fil: Gwako, George. University Of Nairobi; Kenia Fil: Melo Santos, Thiago. University of Melbourne; Australia Fil: Evans, Cherrie. University Johns Hopkins; Estados Unidos Fil: Wakili, Aminu Ado. Bayero University; Nigeria Fil: Bakari, Maisaratu. Bayero University; Nigeria Fil: Takai, Idris Usman. Bayero University; Nigeria Fil: Umar, Mohammad. General Hospital Katsina; Nigeria Fil: Singata-Madliki, Mandisa. University of the Witwatersrand; Sudáfrica Fil: Muller, Elani. University Of Birmingham; Fil: Mandondo, Sibongile. University Of Birmingham; Fil: Okore, Jenipher. University of the Witwatersrand; Sudáfrica Fil: Banda, Akwinata. Muhimbili University Of Health And Allied Sciences; Tanzania Fil: Sambusa, Masumbuko. Muhimbili University Of Health And Allied Sciences; Tanzania Fil: Sindhu, Kulandaipalayam N.. University Of Birmingham; Fil: Beeson, Leanne. University Of Birmingham; Fil: Easter, Christina Louise. University Of Birmingham; Fil: Devall, Adam. University Of Birmingham; Fil: Gülmezoglu, A. Metin. No especifíca; Fil: Althabe, Fernando. Organizacion Mundial de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; Argentina Fil: Gallos, Ioannis. Organizacion Mundial de la Salud; Argentina Fil: Coomarasamy, Arri. University Of Birmingham; Fil: Lorencatto, Fabiana. University College London; Estados Unidos
description	Background: Postpartum haemorrhage is a leading cause of maternal mortality. A multicountry, cluster-randomised trial (E-MOTIVE) demonstrated a 60% reduction in adverse postpartum haemorrhage outcomes. The E-MOTIVE intervention included early postpartum haemorrhage detection using calibrated blood-collection drapes, followed by a postpartum haemorrhage treatment bundle (ie, uterine massage, oxytocics, tranexamic acid, intravenous fluids, examination and escalation [MOTIVE]), supported by implementation strategies. We report a mixed-methods process evaluation assessing the implementation of the E-MOTIVE intervention in Kenya, Nigeria, South Africa, and Tanzania.Methods: In this mixed-methods process evaluation, data sources were observations of health workers providing clinical care to pregnant women and pregnant people during vaginal birth and postpartum haemorrhage at intervention sites, and surveys and qualitative interviews with health workers at intervention and control sites. Intervention sites received the calibrated drapes, MOTIVE bundle, and implementation strategies and control sites used uncalibrated drapes. Primary implementation outcomes included fidelity, adoption, adaptation, acceptability, feasibility, and contamination to the calibrated drape, MOTIVE bundle, and implementation strategies.Findings: Between June 1, 2022, and Jan 31, 2023, 2578 births were observed, 295 pregnant women and people had postpartum haemorrhage, 47 qualitative interviews were done, and 889 surveys were completed. Fidelity to calibrated drape use was high (birth observations 2578 [100%] of 2578; survey 451 [98·3%] of 459). Among health workers, calibrated drape acceptability was high; however, they reported barriers to pregnant women´s and people´s acceptability. Fidelity to postpartum haemorrhage treatment bundle delivery was high (birth observations 286 [96·9%] of 295), with moderate to high fidelity in median time from postpartum haemorrhage diagnosis to final treatment initiation (≤15 min initiation time in 191 [66·8%] of 295 birth observations, 16–20 min in 42 [14·7%] birth observations), and high acceptability and feasibility. Research midwives participated in clinical assessments after birth and bundle delivery in some sites (mixed fidelity).Interpretation: This process evaluation shows generally high levels of fidelity, feasibility, and acceptability of the calibrated drape and treatment bundle across evaluation methods and countries. The E-MOTIVE intervention should be included in national policies, with consideration for health workforce, supplies, and medication issues, which might need addressing for successful implementation.Funding:The Bill and Melinda Gates Foundation and the UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, a co-sponsored programme of WHO.
publishDate	2025
dc.date.none.fl_str_mv	2025-02
dc.type.none.fl_str_mv	info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://purl.org/coar/resource_type/c_6501 info:ar-repo/semantics/articulo
format	article
status_str	publishedVersion
dc.identifier.none.fl_str_mv	http://hdl.handle.net/11336/291228 Bohren, Meghan A.; Miller, Suellen; Mammoliti, Kristie Marie; Galadanci, Hadiza; Fawcus, Sue; et al.; Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation; Elsevier Science Inc.; The Lancet Global Health; 13; 2; 2-2025; 1-16 2214-109X CONICET Digital CONICET
url	http://hdl.handle.net/11336/291228
identifier_str_mv	Bohren, Meghan A.; Miller, Suellen; Mammoliti, Kristie Marie; Galadanci, Hadiza; Fawcus, Sue; et al.; Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation; Elsevier Science Inc.; The Lancet Global Health; 13; 2; 2-2025; 1-16 2214-109X CONICET Digital CONICET
dc.language.none.fl_str_mv	eng
language	eng
dc.relation.none.fl_str_mv	info:eu-repo/semantics/altIdentifier/url/https://linkinghub.elsevier.com/retrieve/pii/S2214109X24004546 info:eu-repo/semantics/altIdentifier/doi/10.1016/S2214-109X(24)00454-6
dc.rights.none.fl_str_mv	info:eu-repo/semantics/openAccess https://creativecommons.org/licenses/by/2.5/ar/
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rights_invalid_str_mv	https://creativecommons.org/licenses/by/2.5/ar/
dc.format.none.fl_str_mv	application/pdf application/pdf
dc.publisher.none.fl_str_mv	Elsevier Science Inc.
publisher.none.fl_str_mv	Elsevier Science Inc.
dc.source.none.fl_str_mv	reponame:CONICET Digital (CONICET) instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str	CONICET Digital (CONICET)
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instname_str	Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv	CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv	dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score	13.265058

Early detection and a treatment bundle strategy for postpartum haemorrhage: a mixed-methods process evaluation

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