Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science




Dr Mickey Kerr

2nd Supervisor

Dr Yolanda Babenko-Mould


3rd Supervisor

Prof Manassé Nzayirambaho


University of Rwanda

Joint Supervisor


Despite recent advances in medical technology and research, postpartum hemorrhage (PPH) remains the top universal cause of maternal morbidity and mortality. Factors underlying PPH include the inconsistency in recognition and timely treatment of women experiencing PPH, which suggests the importance of healthcare professionals’ mentorship about PPH. The aim of this study is to assess the impact of mentorship on nurses’ and midwives’ knowledge and self-efficacy in managing PPH. The pre and post study design recruited 141 nurses and midwives working in the labour and delivery department in selected health centers from the North Province of Rwanda. At post-mentorship, 123 nurses and midwives had completed the study. Using instruments adapted to knowledge and self-efficacy in managing PPH, a paired t-test was applied to estimate differences in scores between pre-and post-mentorship on participants’ knowledge and self-efficacy in managing PPH. The results indicate an increase in knowledge scores from 68% prior to mentorship up to 87% (95% CI [15.65, 21.21] and self-efficacy from 6.9 to 9.5 (95% CI [2.3, 3.08] average score out of the maximum score of ten. The correlation between knowledge and self-efficacy was moderately positive at pre-mentorship (r= .214; p=.002) and strongly positive at post-mentorship (r= .585; p< .001). The frequency of mentorship visits was associated with post-mentorship knowledge scores (r=. 539; p< .001) and post-mentorship self-efficacy (r= .623; p< .001) as well. The results from this research will inform further studies and practitioners to develop a model to support knowledge and self-efficacy in managing PPH.

Summary for Lay Audience

Although different measures and technologies have been used for helping women recover after childbirth, vaginal bleeding, also known as postpartum hemorrhage or PPH for short, continues to be one of the world’s leading causes of death for women after childbirth. Research has indicated that the main reasons PPH remains a problem include the inconsistency in its recognition by health care workers and the lack of timely and effective treatment for women experiencing it. One way to help this, especially in poorer countries where PPH is much more common, is the use of mentorship for healthcare professionals about PPH. The aim of this study was to assess the impact of educational mentorship on Rwandan nurses’ and midwives’ knowledge and confidence in managing PPH after childbirth. The study recruited 141nurses and midwives working in the labour and delivery department in health centres from the Northern Province of Rwanda prior to the educational mentorship. A total of 123 nurses and midwives completed the mentorship and the surveys used in the study were focused on assessing changes in the knowledge and confidence nurses and midwives have in managing PPH after childbirth before and after the mentorship. The mentorship program included monthly visits to the health centres by a trained expert. The study’s statistical analysis tested the difference in their scores before and after six-months of mentorship. The results showed an increase in knowledge about PPH after the educational mentorship, with the scores increasing from 68% to 87%. Their confidence also increased after the mentorship, going from 6.9 to 9.5 on a scale from 1 to 10. The results showed further that there was a moderate relationship between knowledge and confidence before the educational mentorship (r= .214; p=.002) and this relationship increased after the educational mentorship (r= .585; p< .001). Furthermore, as the number of educational mentorship visits that the nurses and midwives attended the more their knowledge and confidence increased. The results from this study will help inform policymakers and educators to develop a sustainable model to support nurses and midwives in Rwanda to better manage women's vaginal bleeding after childbirth.