Psychosocial and Structural Barriers to Seeking, Reaching, and Receiving Care for Obstetric Emergencies and Peripartum Cardiomyopathy Among Pregnant and Early Postpartum Women in Haiti.

Peripartum Cardiomyopathy (PPCM), a form of heart failure in pregnant and early postpartum women, has been shown to have a higher incidence in Haiti compared to the U.S. PPCM can often go unnoticed or misdiagnosed because the signs/symptoms are similar to that of regular pregnancy and may have negative outcomes for women if left untreated. This exploratory study 1) utilized a questionnaire to assess the knowledge, attitudes, and practices (KAP) of health professionals (n=128) regarding obstetric emergencies and PPCM in Haiti, 2) assessed the psychosocial and structural barriers to seeking, reaching, and receiving care for obstetric emergencies and PPCM among 6 focus groups of HIV+ and HIV- pregnant and early postpartum women and 3) translate and adapt the Fett self-test based on four focus groups with physicians and nurses/midwives, and 16 cognitive interviews with Community Advisory Board (CAB) members. In Aim I of the study we found that when assessing knowledge, the nurse/nursing student group had almost 1.5 times more odds (AOR = 1.46, 95% CI: 1.38, 1.55) of scoring higher, and the midwife/midwifery student group had about 2 times more (AOR = 1.98, 95% CI: 1.87, 2.10) odds of scoring higher in knowledge compared to the physician/resident group. In Aim II we found that factors such as 1) knowledge of obstetric emergency signs or symptoms, 2) awareness of eclampsia, 3) transportation, 4) country’s insecurity, 5) negative treatment by medical providers, 6) good interpersonal relationship with medical providers, and 7) perception of women regarding traditional and medical maternal care played a significant role in women seeking, reaching, or receiving care. In Aim III of the study, we developed a final adaptation of the Fett instrument that accounted for cues associated with the reality of our target population and simple enough to be administered by a lower level personnel. The findings from this study can be used to 1) improve training among health providers regarding obstetrical emergencies and PPCM, 2) increase awareness of PPCM among women and develop initiatives that will help bring services to women and 3) implement a Haitian Creole assessment tool to help better facilitate screenings of PPCM.