2023-09-28 14:46:10 +00:00
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abstract: 'Background Postpartum hemorrhage (PPH) is the leading cause of maternal
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mortality in low-income countries, and is the most common direct cause
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of maternal deaths in Madagascar. Studies in Madagascar and other
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low-income countries observe low provider adherence to recommended
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practices for PPH prevention and treatment. Our study addresses gaps in
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the literature by applying a behavioral science lens to identify
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barriers inhibiting facility-based providers'' consistent following of
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PPH best practices in Madagascar. Methods In June 2019, we undertook a
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cross-sectional qualitative research study in peri-urban and rural areas
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of the Vatovavy-Fitovinany region of Madagascar. We conducted 47
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in-depth interviews in 19 facilities and five communities, with
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facility-based healthcare providers, postpartum women, medical
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supervisors, community health volunteers, and traditional birth
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attendants, and conducted thematic analysis of the transcripts. Results
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We identified seven key behavioral insights representing a range of
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factors that may contribute to delays in appropriate PPH management in
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these settings. Findings suggest providers'' perceived low risk of PPH
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may influence their compliance with best practices, subconsciously or
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explicitly, and lead them to undervalue the importance of PPH prevention
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and monitoring measures. Providers lack clear feedback on specific
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components of their performance, which ultimately inhibits continuous
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improvement of compliance with best practices. Providers demonstrate
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great resourcefulness while operating in a challenging context with
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limited equipment, supplies, and support; however, overcoming these
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challenges remains their foremost concern. This response to chronic
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scarcity is cognitively taxing and may ultimately affect clinical
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decision-making. Conclusions Our study reveals how perception of low
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risk of PPH, limited feedback on compliance with best practices and
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consequences of current practices, and a context of scarcity may
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negatively affect provider decision-making and clinical practices.
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Behaviorally informed interventions, designed for specific contexts that
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care providers operate in, can help improve quality of care and health
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outcomes for women in labor and childbirth.'
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affiliation: 'Flanagan, SV (Corresponding Author), Ideas42, 80 Broad St Fl 30, New
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York, NY 10004 USA.
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Flanagan, Sara V.; Razafinamanana, Tina; Smith, Jana, Ideas42, 80 Broad St Fl 30,
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New York, NY 10004 USA.
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Warren, Charlotte, Populat Council, 4301 Connecticut Ave NW, Washington, DC 20008
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USA.'
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article-number: '320'
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author: Flanagan, Sara V. and Razafinamanana, Tina and Warren, Charlotte and Smith,
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Jana
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author-email: sara@ideas42.org
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author_list:
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- family: Flanagan
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given: Sara V.
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- family: Razafinamanana
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given: Tina
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- family: Warren
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given: Charlotte
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- family: Smith
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given: Jana
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da: '2023-09-28'
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doi: 10.1186/s12884-021-03801-w
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eissn: 1471-2393
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files: []
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journal: BMC PREGNANCY AND CHILDBIRTH
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keywords: 'Maternal mortality; Postpartum hemorrhage; Healthcare provider;
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Madagascar; Facility-based birth; Behavioral barriers'
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keywords-plus: '3RD STAGE; ACTIVE MANAGEMENT; RISK PERCEPTION; CONDOM USE; LABOR;
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IMPLEMENTATION; FEEDBACK'
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language: English
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month: APR 22
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number: '1'
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number-of-cited-references: '33'
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papis_id: 60680c68062ab8abae46c0d29a56e8f4
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ref: Flanagan2021barriersinhibiting
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times-cited: '4'
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title: 'Barriers inhibiting effective detection and management of postpartum hemorrhage
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during facility-based births in Madagascar: findings from a qualitative study using
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a behavioral science lens'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000644071000002
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usage-count-last-180-days: '0'
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usage-count-since-2013: '1'
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volume: '21'
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web-of-science-categories: Obstetrics \& Gynecology
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year: '2021'
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