Mentorship Effect On Healthcare Providers' Adherence To Postpartum Hemorrhage Clinical Guidelines And Maternal Outcomes In Muhima District Hospital Catchment Area..

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