Table 3.
Scenario results on the annual health and economic burden of postpartum hemorrhage in Senegal
| PPH ≥ 500 ml | PPH ≥ 1000 ml | Additional uterotonic treatment | Blood transfusions | Deaths due to PPH | Total economic burden of PPH | Total OOP costs public | Total OOP costs private | Long term productivity loss | |
|---|---|---|---|---|---|---|---|---|---|
| 0. Baseline estimate | 86,542 | 21,152 | 35,250 | 14,408 | 447 | $19,499,322 | $1,774,990 | $833,766 | $16,890,566 |
| 1. No substandard uterotonics | 81,540 | 19,769 | 29,331 | 9,643 | 418 | $18,221,486 | $1,615,355 | $787,498 | $15,818,633 |
| Difference | -5,002 | -1,383 | -5,918 | -4,765 | -28 | -$1,277,836 | -$159,634 | -$46,268 | -$1,071,933 |
| Difference % | -6% | -7% | -17% | -33% | -6% | -7% | -9% | -6% | -6% |
| 2. Quality misoprostol + oxytocin for facility births | 75,117 | 19,005 | 25,647 | 8,470 | 402 | $17,273,438 | $1,408,674 | $678,574 | $15,186,190 |
| Difference | -11,425 | -2,146 | -9,603 | -5,938 | -45 | -$2,225,883 | -$366,315 | -$155,192 | -$1,704,376 |
| Difference % | -13% | -10% | -27% | -41% | -10% | -11% | -21% | -19% | -10% |
| 3. Quality heat-stable carbetocin for facility births | 76,250 | 19,334 | 26,277 | 8,669 | 408 | $17,619,801 | $1,463,591 | $711,814 | $15,444,396 |
| Difference | -10,292 | -1,818 | -8,972 | -5,738 | -38 | -$1,879,521 | -$311,398 | -$121,952 | -$1,446,170 |
| Difference % | -12% | -9% | -25% | -40% | -9% | -10% | -18% | -15% | -9% |
| 4. Misoprostol at reported level of quality for home births | 74,344 | 20,132 | 35,009 | 14,231 | 426 | $18,701,065 | $1,766,432 | $832,082 | $16,102,551 |
| Difference | -12,198 | -1,020 | -241 | -177 | -21 | -$798,257 | -$8,557 | -$1,685 | -$788,015 |
| Difference % | -14% | -5% | -1% | -1% | -5% | -4% | 0% | 0% | -5% |
| 5. Quality misoprostol for home births | 72,005 | 19,526 | 34,888 | 14,139 | 412 | $18,168,530 | $1,762,548 | $833,887 | $15,572,094 |
| Difference | -14,537 | -1,626 | -362 | -269 | -35 | -$1,330,792 | -$12,441 | $121 | -$1,318,471 |
| Difference % | -17% | -8% | -1% | -2% | -8% | -7% | -1% | 0% | -8% |
| 6. All deliveries happen in facilities | 70,632 | 19,117 | 44,603 | 18,114 | 405 | $18,475,308 | $2,229,428 | $951,006 | $15,294,874 |
| Difference | -15,910 | -2,035 | 9,353 | 3,706 | -42 | -$1,024,014 | $454,438 | $117,239 | -$1,595,692 |
| Difference % | -18% | -10% | 27% | 26% | -9% | -5% | 26% | 14% | -9% |
| 7. All deliveries happen in facilities with quality-assured uterotonics | 64,110 | 17,370 | 36,938 | 11,933 | 367 | -$16,799,964 | $2,023,821 | $896,540 | $13,879,602 |
| Difference | -22,431 | -3,782 | 1,689 | -2,475 | -80 | -$2,699,358 | $248,832 | $62,774 | -$3,010,964 |
| Difference % | -26% | -18% | 5% | -17% | -18% | -14% | 14% | 8% | -18% |
OOP: out-of-pocket; PPH: postpartum hemorrhage
Scenario descriptions: (1) No substandard uterotonics: The uterotonics provided at healthcare facilities are quality assured. (2) Quality misoprostol + oxytocin for facility births: All women in facilities receive both misoprostol and oxytocin, and they are quality assured. (3) Quality heat-stable carbetocin for facility births: All women in facilities receive heat-stable carbetocin and it is quality assured. (4) Misoprostol at reported level of quality for home births: Home birthing women utilize misoprostol at reported level of quality. (5) Quality misoprostol for home births: Home birthing women utilize quality-assured misoprostol. (6) All deliveries happen in facilities: All women are modeled to utilize facility care. The use and quality of uterotonics in facilities remain as baseline. (7) All deliveries happen in facilities with quality-assured uterotonics: All women are modeled to utilize facility care. The use of uterotonics in facilities remains at baseline. The uterotonics provided are quality-assured.