Introduction of Heat-Stable Carbetocin for Postpartum Hemorrhage Prevention in Public Sector Hospitals in Kenya: Provider Experience and Policy Insights.

Abstract

Background and objective: In Kenya, the leading cause of maternal deaths is obstetric hemorrhage (39.5%), with postpartum hemorrhage (PPH) accounting for 50% with quality of uterotonics as one of the biggest challenges. The World Health Organization (WHO) in 2018 included heat-stable carbetocin (HSC) for the prevention of PPH in settings where the quality of oxytocin cannot be guaranteed. Maintenance of the cold chain for uterotonics is a challenge. HSC does not require refrigeration, reducing pressure on the fragile cold chain infrastructure. The main objective was to understand PPH prevention knowledge, experience, and perspectives, including uterotonic use, by policymakers and healthcare providers (HCPs) in the public health sector in ten counties in Kenya. HCP knowledge, perception, and experience were assessed after the HSC introduction.

Methods: The mixed methods study was implemented in 39 secondary and tertiary public hospitals from ten counties. Quantitative interviews targeting 171 HCPs at baseline and end-line were collected using REDCap software (v5.26.4) and analyzed using Stata version 17. Qualitative data was collected from 19 policymakers at the national, county, sub county, and health facility levels and analyzed using NVIVO 12.

Results: At the end line, 98.8% had administered HSC for the prevention of PPH, while 96.5% of the HCPs were aware that their facilities had protocols/guidelines in place on the use of HSC. To enhance awareness of WHO recommendations on the use of HSC among HCPs, a top-down approach was used. Over 90% of HCPs agreed that HSC was easy to administer and distinguish from other uterotonics. Policymakers agreed that there was value in the HSC introduction in the public health sector that experiences cold chain challenges and recommended budgetary allocation.

Conclusion and global health implications: The findings demonstrate that HCP's knowledge, perception, and experience coupled with the policymaker's perspective is the key to the introduction of HSC in the public sector. Policymakers find value in introducing HSC as it alleviates challenges with the fragile cold chain systems. This study contributes to the global body of knowledge on the introduction of lifesaving commodities, which is anticipated to potentially improve PPH prevention and management, and hence reduce maternal mortality.