Open Access Open Badges Research article

Local health workers’ perceptions of substandard care in the management of obstetric hemorrhage in rural Malawi

Jogchum Jan Beltman12*, Thomas van den Akker123, Dieudonné Bwirire3, Anneke Korevaar4, Richard Chidakwani1, Luc van Lonkhuijzen5 and Jos van Roosmalen26

Author Affiliations

1 Thyolo District Health Office, Ministry of Health, Thyolo, Malawi

2 Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands

3 Médicins Sans Frontières, Thyolo, Malawi

4 Department of Obstetrics, University Medical Centre Groningen, Groningen, The Netherlands

5 Department of Gynecologic Oncology, University of Toronto, Toronto, Canada

6 Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands

For all author emails, please log on.

BMC Pregnancy and Childbirth 2013, 13:39  doi:10.1186/1471-2393-13-39

Published: 15 February 2013



To identify factors contributing to the high incidence of facility-based obstetric hemorrhage in Thyolo District, Malawi, according to local health workers.


Three focus group discussions among 29 health workers, including nurse-midwives and non-physician clinicians (‘medical assistants’ and ‘clinical officers’).


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.


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.