Knowledge, attitude and practice of emergency care providers on obstetric haemorrhage in KwaZulu-Natal, South Africa: A cross-sectional study

Background

Obstetric haemorrhage (OH) is a leading cause of maternal deaths worldwide. The South African Department of Health recommends that all childbirths be managed by skilled personnel who can identify and manage complications to reduce adverse maternal, perinatal and neonatal outcomes. Emergency Care (EC) providers are prehospital personnel mandated to fulfil this role; however, little is known about their knowledge, attitudes and practices (KAP) for OH emergencies. This study assesses EC providers’ knowledge (specifically pathophysiology, diagnosis and treatment), attitude and practices regarding OH management in KwaZulu-Natal (KZN), South Africa.

Methods

A cross-sectional KAP survey was administered to public-sector EC providers at designated central locations in each of the 11 KZN districts, with participants representing multiple ambulance stations in their respective districts. Data were collected through a structured questionnaire completed by 417 participants enrolled between July 2022 and August 2023. Modified Bloom’s cut-off points were used to develop KAP scores, enabling categorical assessment. Data analysis included descriptive and inferential statistics.

Results

Participants (n = 417) were predominantly male (75.3 %, n = 314). The majority were aged ≥40 years (66.4 %, n = 277), ranging from 18 to 60 years. Regarding OH, 95.7 % demonstrated poor knowledge, 65.5 % a positive attitude and 96.6 % poor practices. The Kruskal-Wallis test (p < 0.001) showed knowledge scores varied substantially by qualification level. Logistic regression indicated higher qualifications were associated with better knowledge, attitude and practices.

Conclusion

Targeted up-skilling and mandatory obstetric simulation for EC providers in KZN are needed to close knowledge-practice gaps. Despite a positive attitude, EC providers demonstrated poor knowledge and practices in OH management. These shortcomings appear influenced by systemic and contextual barriers and require further investigation. Nevertheless, our findings highlight the importance of sustained, targeted training and EMS support to address critical gaps and improve obstetric outcomes in emergency settings.