Cost of hospital care of women with postpartum haemorrhage in India, Kenya, Nigeria and Uganda: a financial case for improved prevention

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Cost of hospital care of women with postpartum haemorrhage in India, Kenya, Nigeria and Uganda: a financial case for improved prevention


JournalReproductive Health
Article typeJournal research article – Clinical research
Publication date – Jan – 2021
Authors – Fiona Theunissen, Isotta Cleps, Shivaprasad Goudar, Zahida Qureshi, Olorunfemi Oludele Owa, Kidza Mugerwa, Gilda Piaggio, A. Metin Gülmezoglu, Miriam Nakalembe, Josaphat Byamugisha, Alfred Osoti, Sura Mandeep, Teko Poriot, George Gwako, Sunil Vernekar & Mariana Widmer
Keywordscost, Heat stable carbetocin, Oxytocin, Postpartum haemorrhage, PPH
Open access – Yes
SpecialityHealth policy, Obstetrics and Gynaecology
World region Eastern Africa, Southern Asia, Western Africa
Country: India, Kenya, Nigeria, Uganda
Language – English
Submitted to the One Surgery Index on January 30, 2021 at 7:09 am
Abstract:

Objective
Access to quality, effective lifesaving uterotonics in low and middle-income countries (LMICs) remains a major barrier to reducing maternal deaths from postpartum haemorrhage (PPH). Our objective was to assess the costs of care for women who receive different preventative uterotonics, and with PPH and no-PPH so that the differences, if significant, can inform better resource allocation for maternal health care.

Methods
The costs of direct hospital care of women who received oxytocin or heat-stable carbetocin for prevention of PPH in selected tertiary care facilities in India, Kenya, Nigeria, and Uganda were assessed. We collected data from all women who had PPH, as well as a random sample of women without PPH. Cost data was collected for the cost of stay, PPH interventions, transfusions and medications for 2966 women. We analyzed the difference in cost of care at a facility level between women who experienced a PPH event and those who did not.

Key findings

The mean cost of care of a woman experiencing PPH in the study sites in India, Kenya, Nigeria, and Uganda exceeded the cost of care of a woman who did not experience PPH by between 21% and 309%. There was a large variation in cost across hospitals within a country and across countries.

Conclusion
Our results quantify the increased cost of PPH of up to 4.1 times that for a birth without PPH. PPH cost information can help countries to evaluate options across different conditions and in the formulation of appropriate guidelines for intrapartum care, including rational selection of quality-assured, effective medicines. This information can be applied to national assessment and adaptation of international recommendations such as the World Health Organization’s recommendations on uterotonics for the prevention of PPH or other interventions used to treat PPH.

OSI Number – 20905

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