ArticleInternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics2026
Availability, cost, and budget impact of lifesaving postpartum hemorrhage interventions in public hospitals in Zambia: A cross-sectional survey.
Article in International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivePostpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Most PPH deaths are preventable through evidence-based interventions. This study assessed the availability, direct costs, and economic implications of World Health Organization-recommended PPH interventions in public hospitals in Zambia.
methodsA cross-sectional survey was conducted in 31 purposively selected public hospitals across seven provinces. Data (June 2019 to May 2020) on PPH prevalence, resource availability, and direct costs of PPH interventions were collected via a structured questionnaire administered to hospital administrators. An ingredients-based costing model compared an ideal pathway (severe PPH managed at a fully equipped primary-level health facility) to a referral pathway (patients unresponsive to early-stage interventions transferred to a tertiary hospital). Data were analyzed using Python.
resultsAmong 74 238 deliveries, 1957 (2.6%) were PPH cases, resulting in 94 (4.8%) fatalities. Most cases (86.9%) received medical management, primarily by nurse-midwives. Tranexamic acid (TXA) was available in only 58.1% of the hospitals (subsidized cost: US$1.91/dose). Managing a severe PPH case in the ideal pathway cost US$133.46-US$276.22, compared to US$153.34-US$332.53 via the referral pathway , representing an 18.6% increase. Scaled nationally (approximately 672 000 births), this inefficiency translates to an avoidable annual burden of US$133121.
conclusionWhile oxytocin is universally available, access to critical treatments such as TXA and advanced interventions remains limited. The low cost of preventive interventions contrasts with the high cost of managing severe PPH, which is exacerbated by system fragmentation. Strengthening primary-level facilities with essential commodities, surgical capacity, and training is critical to containing costs and reducing maternal mortality due to PPH.
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