title: Local health workers' perceptions of substandard care in the management of obstetric hemorrhage in rural Malawi.
abstract: BACKGROUND
  To identify factors contributing to the high incidence of facility-based obstetric hemorrhage in Thyolo District, Malawi, according to local health workers.
  
  
  METHODS
  Three focus group discussions among 29 health workers, including nurse-midwives and non-physician clinicians ('medical assistants' and 'clinical officers').
  
  
  RESULTS
  Factors contributing to facility-based obstetric hemorrhage mentioned by participants were categorized into four major areas: (1) limited availability of basic supplies, (2) lack of human resources, (3) inadequate clinical skills of available health workers and (4) substandard referrals by traditional birth attendants and lack of timely self-referrals of patients.
  
  
  CONCLUSIONS
  Health workers in this district mentioned important community, system and provider related factors that need to be addressed in order to reduce the impact of obstetric hemorrhage.
authors: Thyolo District Health Office, Ministry of Health, Thyolo, Malawi. j.j.beltman@lumc.nl
authors: Jogchum Jan
authors: JJ
authors: Beltman
authors: Thomas
authors: T
authors: van den Akker
authors: Dieudonné
authors: D
authors: Bwirire
authors: Anneke
authors: A
authors: Korevaar
authors: Richard
authors: R
authors: Chidakwani
authors: Luc
authors: L
authors: van Lonkhuijzen
authors: Jos
authors: J
authors: van Roosmalen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003150:Community Health Workers; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006801:Humans; D015994:Incidence; D008295:Malawi; D008875:Middle Aged; D008880:Midwifery; D009721:Nurse Midwives; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D011247:Pregnancy; D012424:Rural Population