Misoprostol for the prevention of postpartum hemorrhage during home births in rural Lao PDR: establishing a pilot program for community distribution

Abstract

PurposeThe purpose of this study was to gather the necessary data to support the design and implementation of a pilot program for women who are unable to deliver in a healthcare facility in the Lao People’s Democratic Republic (PDR), by using community distribution of misoprostol to prevent postpartum hemorrhage (PPH). The study builds on an earlier research that demonstrated both support and need for community-based distribution of misoprostol in Lao PDR.MethodsThis qualitative study identified acceptability of misoprostol and healthcare system needs at varying levels to effectively distribute misoprostol to women with limited access to facility-based birthing. Interviews (n=25) were undertaken with stakeholders at the central, provincial, and district levels and with community members in five rural communities in Oudomxay, a province with high rates of maternal mortality. Focus group discussions (n=5) were undertaken in each community.ResultsRespondents agreed that PPH was the major cause of preventable maternal mortality with community distribution of misoprostol an acceptable and feasible interim preventative solution. Strong leadership, training, and community mobilization were identified as critical success factors. While several participants preferred midwives to distribute misoprostol, given the limited availability of midwives, there was a general agreement that village health workers or other lower level workers could safely administer misoprostol. Many key stakeholders, including women themselves, considered that these community-level staff may be able to provide misoprostol to women for self-administration, as long as appropriate education on its use was included. The collected data also helped identify appropriate educational messages and key indicators for monitoring and evaluation for a pilot program.ConclusionThe findings strengthen the case for a pilot program of community distribution of misoprostol to prevent PPH in remote communities where women have limited access to a health facility and highlight the key areas of consideration in developing such a program.

Effect of community-based distribution of misoprostol on facility delivery: a scoping review

“…Seven of the studies were from Africa and the remaining seven were from Asia. Three qualitative studies [12, 26, 42], seven observational studies [35–37, 40, 43–45], and four experimental or quasi-experimental studies [38, 39, 41, 46] were included in this review. All studies were published from 2006 to 2018.…”

“…Eleven studies (five observational before-after studies, four experimental or quasi-experimental trials, and two qualitative study) reported on the impact on facility birth as the outcome [26, 35–42, 45, 46]. All five before-after household surveys reported increased facility delivery coverage after the intervention: four percentage points increase in Nepal [37] and Liberia [40], 11% points in Afghanistan [36], 39% points in Ghana [35], and 46% points in India [45] at the end of the intervention when compared to the baseline (Fig.…”

Qualitative Study on Nutrition- and Health-Related Knowledge Attitudes and Practices in Four High Stunting Regions of Lao PDR

“…Some women still preferred to birth at home or had an at-home birth because of poor physical access due to the lack of all-weather roads, lack of transport (or high cost of transport), or opportunity costs. Travel can be particularly arduous for women who are pregnant, in labor, or are transporting small children (Durham et al 2018;Ensor and Cooper 2004;Jacobs et al 2012;Durham et al 2016;Okwaraji, Webb, and Edmond 2015;Sychareun et al 2012), particularly in the absence of all-weather roads. Other reasons given for not delivering their child at a health facility included going into labor quickly and lack of perceived benefits from institutional birthing.…”

“…Other reasons given for not delivering their child at a health facility included going into labor quickly and lack of perceived benefits from institutional birthing. These barriers are well documented in Lao PDR as well as in other lower-middle-income countries (World Bank 2005;Durham et al 2018;Eckermann and Deodato 2008;Ensor and Cooper 2004;Jacobs et al 2012;Levesque, Harris, and Russell 2013;Durham et al 2016;Sychareun et al 2012Sychareun et al , 2013Sychareun et al , 2016Okwaraji, Webb, and Edmond 2015;Lee et al 2013) and are related to the basic causes of poor maternal and child health and undernutrition as recognized in the UNICEF Conceptual Framework of Undernutrition (UNICEF 2015).…”

“…Mothers' self-reported satisfaction with services related to ANC and delivery was high, although women who did not speak Lao found it hard to understand what they were being told, even with translation. This also highlights that the quality of care offered in facilities to women giving birth and to their newborn children must improve and be culturally responsive (Durham et al 2018;Nesbitt et al 1990). Furthermore, some women, especially in Hmong villages, did not always feel they were able to make decisions about seeking health care.…”