MGHD 2023

Background: Postpartum hemorrhage (PPH) is globally the primary cause of maternal mortality and morbidity. Adherence to clinical guidelines plays a vital role in the effective management of PPH, and mentorship programs have been implemented to enhance the knowledge and skills of Health care providers (HCPs) and adherence to clinical guidelines. However, there is a need to know if they improved adherence to guidelines and maternal outcomes. This study aimed to assess the effect of a clinical mentorship program on healthcare providers' adherence to PPH clinical guidelines and maternal outcomes in the Muhima District Hospital catchment area. Methods: A quasi-experimental design was employed, comparing the same healthcare providers’ adherence to clinical guidelines before and after mentorship. Maternal outcomes were also evaluated in relation to adherence to clinical guidelines. Adherence to clinical guidelines and maternal outcomes were assessed based on standardized medical records. We used consecutive sampling, where cases were added one after another as they appeared in medical registers. Statistical analyses, including the Mann-Whitney test, bivariate (Chi-square and Fischer’s exact tests), and multivariate regression analysis, were conducted to explore the relationship between mentorship and adherence to guidelines and between adherence to guidelines and maternal outcomes. Results: 384 women who had PPH were included in the study. Adherence to clinical guidelines among healthcare providers in managing PPH was (96.4%) before and (95.8%) after the mentorship program. No significant association was found between mentorship and adherence to guidelines (p-value=0.792). However, adherence to clinical guidelines was significantly associated with favorable maternal outcomes (p-value< 0.001). Multivariate regression analysis showed much lower odds of experiencing no complications (AOR= 0.011, 95% CI: 0.002-0.073) for those whose management did not adhere to the guidelines compared to the group which showed adherence. Additionally, estimated blood loss between 500 ml and 1000 ml had higher odds (AOR= 286.777, 95% CI:31.130- 2641.895) of resulting in no complications compared to blood loss of more than 1000 ml. Conclusion: Adherence to clinical guidelines is essential to ensure high-quality care and improve maternal outcomes in PPH cases. The study confirms the effect of adherence to guidelines on maternal outcomes, highlighting the need to promote and strengthen adherence to clinical guidelines. Nonetheless, it became clear that mentorship alone cannot be considered the sole factor determining adherence, implying that other elements, like programs offered by external institutions, may have an influence. Recommendations: Future research should focus on assessing other metrics for adherence and explore barriers and facilitators to adherence in qualitative studies. Promoting adherence to clinical guidelines