Magnitude and Determinants of Postpartum Hemorrhage in Sub-Saharan Africa–Author Interview

27 June 2025

We are extremely honored to have interviewed Dr. Enos Moyo. He is an experienced doctor, public health expert, and health economist, having worked in the field of African public health for over 20 years. His research findings revealed that the incidence of postpartum hemorrhage PPH in this region is as high as 8.6%, much higher than in other areas. He also pointed out that "failing to conduct antenatal care ANC on time" is a key risk factor. In this interview, Dr. Moyo will share his research insights, the challenges he has faced, and the hopes he sees for the future, including how artificial intelligence (AI) may potentially help improve maternal care. We hope this exchange offers valuable inspiration to researchers, clinicians, and students alike.

1. Can you briefly describe your academic background and current research interests?

I am a Public Health/HIV Specialist and Health Economist with over 20 years of experience as a medical doctor. I attained my medical degree from the University of Zimbabwe in 2003. Thereafter, I attained a Master of Business Administration from Regent Business School in South Africa, a Master of Philosophy in HIV/AIDS Management from Stellenbosch University, a Master of Public Health from the University of Johannesburg in South Africa, a Master of Science in Applied Health Economics from the University of South Wales in the United Kingdom, and a Doctor of Philosophy (PhD) in Public Health Medicine from the University of KwaZulu-Natal in South Africa. I have several postgraduate diplomas in General Practice, Business Analytics, Clinical Pharmacology, and Clinical Research. I have published 84 peer-reviewed journal articles in international journals. My research interests include HIV/AIDS, public health, infectious diseases, maternal and child health, climate change, migration, and health economics.

2. What was the initial opportunity that prompted you to focus on maternal and child health in Sub-Saharan Africa (SSA)?

What prompted me to focus on maternal and child health in SSA was my experience in the region. The maternal and child health outcomes for SSA are poor compared to other regions. Having worked in Zimbabwe and Namibia over the past 22 years, I witnessed several avoidable maternal and child deaths, which made me acutely aware of the urgency and necessity of improving health outcomes in this field.

3. In your research, you found that the prevalence of PPH in SSA is as high as 8.6%. What do you think is the main reason for this figure being much higher compared to other regions?

Women in SSA have low utilization rates of postnatal care services due to a variety of factors, including their sociodemographic characteristics and aspects of the health systems, like inaccessibility of healthcare facilities and the poor standard of care. A shortage of skilled birth attendants, medications to control bleeding, and equipment in SSA might also contribute to higher PPH rates.

4. Systematic review and Meta-analysis methods were used in this study, what challenges did you encounter during the collection and screening of literature?

One of the main challenges was accessing articles that do not have open access. We had to raise money as authors to gain access to the articles that were relevant to the study. Another challenge is that it was always difficult to meet virtually as authors to discuss the progress of our study since we are based in different countries and are practicing health practitioners.

5. Which risk factors (e.g. advanced age, multiple pregnancies, anaemia, etc.) surprised or impressed you the most in this study? Why?

While most of the risk factors identified are biologically plausible, non-attendance of ANC was somewhat surprising because there is no biological explanation for it. However, it might be attributed to the fact that increased ANC attendance can improve the identification and management of pre-existing conditions that elevate PPH risk.

6. In the direction of your focus, what do you think may be the hotspots for future research?

The study revealed statistically significant differences in the prevalence of PPH by sample size. The focus should be on conducting studies with large sample sizes that cover most of the countries in the region. There should also be standardization of the studies to ensure that they are homogeneous.

7. How do you think this study can guide local public health policy makers?

One of the identified risk factors for PPH is ANC non-attendance. Public health policymakers should address ANC non-attendance by implementing strategies that can increase ANC utilization among women in the region. The strategies may include ensuring that healthcare facilities are located near where people live, especially in rural areas, making use of community health workers, removing user fees, and providing health education to the target group.

8. It is mentioned in the article that artificial intelligence can be used to predict PPH, how do you see the role of AI in the future of maternal management?

There are several ways in which AI can be used in maternal and fetal management. AI has the potential to greatly improve maternal and fetal healthcare through enhanced early detection and diagnosis, personalized care, remote monitoring and telemedicine, support for clinical decision-making, optimization of healthcare resource allocation, and facilitation of continuous learning and improvement. AI algorithms are capable of analyzing data to detect potential complications such as preeclampsia, gestational diabetes, and preterm labor at an early stage, facilitating timely intervention. AI can tailor treatment plans according to individual patient characteristics, medical history, and genetic factors, thereby enhancing care and outcomes. AI-enabled devices and platforms can facilitate remote monitoring of maternal health indicators, especially in remote or underserved regions, thereby enhancing access to care. AI can be used to assess fetal heart rate patterns and various indicators of fetal health to identify potential issues at an early stage, thereby facilitating more precise and timely interventions. AI can also aid healthcare professionals in decision-making by offering insights derived from patient data and forecasting potential outcomes. Additionally, AI has the capability to automate routine administrative tasks, thereby allowing healthcare providers to concentrate on patient care.

9. This study was chosen to be published in the journal Clinical and Experimental Obstetrics & Gynecology (CEOG), what factors did you base your submission decision on? For example, impact factor, speed of review, readership, databases included there etc.?

We submitted our manuscript to CEOG because it is an international, peer-reviewed, and open-access journal. It is indexed in several databases, such as the Web of Science, Scopus, DOAJ, CNKI, and SciFinder, which ensures that the manuscript has high visibility, allowing the study findings to be read by many scientists and other interested stakeholders, like policymakers and the public.

10. What advice would you give to young scholars interested in global health or maternal and child health research?

Emerging researchers in global health should pursue varied experiences, cultivate effective communication abilities, and emphasize impact and sustainability. It is essential to prioritize ethical considerations and develop a comprehensive understanding of the social determinants of health. Global health includes multiple domains, ranging from clinical practice to research and policy development. Emerging researchers should actively pursue opportunities in fields of their interest, including public health, epidemiology, and health policy. Engagement in global health initiatives within their communities is essential for skill development and networking opportunities. It is essential for them to enhance their presentation and writing skills, as global health professionals frequently must convey their research and findings to varied audiences. Emerging researchers should comprehend the influence of factors such as poverty, education, housing, and resource accessibility on health outcomes, acknowledging that health disparities frequently stem from larger social and economic structures.

11. What was your experience in publishing your article with CEOG?

I found the submission process to CEOG to be very smooth. The journal's website is easy to navigate and provides detailed submission guidelines, which greatly facilitated my submission. The peer review process was highly efficient, and the journal provided timely updates on the review status. The reviewers offered constructive feedback, which significantly improved the quality of our manuscript.

We are extremely grateful to Dr. Enos Moyo for sharing his valuable insights and experiences. We believe that these real-life experiences and scientific insights from the frontline in Africa will provide important inspiration for readers, practitioners, and decision-makers who are concerned about global health. We look forward to Dr. Enos Moyo continuing to work together with us in the future to bring more valuable academic content to the field of obstetrics and gynecology!

Read the article:

Magnitude and Determinants of Postpartum Hemorrhage in Sub-Saharan Africa: A Systematic Review and Meta-Analysis: https://doi.org/10.31083/j.ceog5110229

Analysis of Risk Factors for Severe Postpartum Hemorrhage: https://doi.org/10.31083/j.ceog5108171

Prevalence and Risk Factors for Neck and Upper Limb Musculoskeletal Disabilities Among Postpartum Women: https://doi.org/10.31083/CEOG25833

Retrospective Analysis of the Effects of Maternal Thyroid Dysfunction on Obstetrical Complications and Outcomes in a Cohort of 17,219 Pregnant Women: https://doi.org/10.31083/CEOG27087