A case study of community-based distribution and use of Misoprostol and Chlorhexidine in Sokoto State, Nigeria

Cannon, Molly; Charyeva, Zulfiya; Oguntunde, Olugbenga; Sambisa, William; Shoretire, Kamil; Orobaton, Nosa

doi:10.1080/17441692.2016.1172102

Cited by 7 publications

(8 citation statements)

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“…The second was the inequitable distribution of CBHVs linked with widely dispersed populations in some LGAs that may have missed some mothers. [ 33 ] The third, also confirmed by a recent study of the program, were delays in the timely release of misoprostol from health facilities to CDK on one hand, and between CDK and women in need, on the other. There were instances of husbands’ rejection of the medicines.…”

Section: Discussionmentioning

confidence: 87%

“…There were instances of husbands’ rejection of the medicines. [ 33 ] However, the majority of men—community leaders and husbands—strongly endorsed misoprostol distribution across all 244 wards in the state. This strong endorsement was further supported by the visible impact of misoprostol on reducing maternal bleeding, which quite likely, further strengthened community demand for misoprostol.…”

Section: Discussionmentioning

confidence: 99%

“…This strong demand and acceptance of misoprostol has also been confirmed by another study, and communities highlighted its observed quick-acting effect to stop postpartum bleeding. [ 33 ] The successful transportation to health centers of 33 women that suffered heavy bleeding, also likely averted PPH-related deaths. Yet, 11 maternal deaths could also potentially have been averted were they referred as well.…”

Section: Discussionmentioning

confidence: 99%

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Implementing at-scale, community-based distribution of misoprostol tablets to mothers in the third stage of labor for the prevention of postpartum haemorrhage in Sokoto State, Nigeria: Early results and lessons learned

Orobaton¹,

Jumare²,

Abegunde³

et al. 2017

PLoS ONE

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BackgroundPostpartum haemorrhage (PPH) is a leading cause of maternal death in Sokoto State, Nigeria, where 95% of women give birth outside of a health facility. Although pilot schemes have demonstrated the value of community-based distribution of misoprostol for the prevention of PPH, none have provided practical insight on taking such programs to scale.MethodsA community-based system for the distribution of misoprostol tablets (in 600ug) and chlorhexidine digluconate gel 7.1% to mother-newborn dyads was introduced by state government officials and community leaders throughout Sokoto State in April 2013, with the potential to reach an estimated 190,467 annual births. A simple outcome form that collected distribution and consumption data was used to assess the percentage of mothers that received misoprostol at labor through December 2014. Mothers’ conditions were tracked through 6 weeks postpartum. Verbal autopsies were conducted on associated maternal deaths.ResultsMisoprostol distribution was successfully introduced and reached mothers in labor in all 244 wards in Sokoto State. Community data collection systems were successfully operational in all 244 wards with reliable capacity to record maternal deaths. 70,982 women or 22% of expected births received misoprostol from April 2013 to December 2014. Between April and December 2013, 33 women (< 1%) reported that heavy bleeding persisted after misoprostol use and were promptly referred. There were a total of 11 deaths in the 2013 cohort which were confirmed as maternal deaths by verbal autopsies. Between January and December of 2014, a total 434 women (1.25%) that ingested misoprostol reported associated side effects.ConclusionIt is feasible and safe to utilize government guidelines on results-based primary health care to successfully introduce community distribution of life saving misoprostol at scale to reduce PPH and improve maternal outcomes. Lessons from Sokoto State’s at-scale program implementation, to assure every mother’s right to uterotonics, can inform scale-up elsewhere in Nigeria.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Implementing at-scale, community-based distribution of misoprostol tablets to mothers in the third stage of labor for the prevention of postpartum haemorrhage in Sokoto State, Nigeria: Early results and lessons learned

Orobaton¹,

Jumare²,

Abegunde³

et al. 2017

PLoS ONE

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“…Collectively, these findings demonstrate the challenges of implementation science in maternity care within nations that are less than affluent. To manage sociocultural barriers, it can be helpful to adapt an intervention to a given context [113,140,159,161]-this might Mixed-methods 27 Case study 12 [139][140][141][142][143][144][145][146][147][148][149][150] Pre-post study 8 [151][152][153][154][155][156][157][158] Ethnography 6 [159][160][161][162][163][164] Cohort study 4 [165][166][167][168] Pilot-test 8 [169][170][171][172][173][174][175][176] Longitudinal survey 2 [177,178] Quasi-experimental 1 [179] Randomised controlled trial 2 [180,…”

Section: Theories Models and Framework: Absentmentioning

confidence: 99%

Implementation science in maternity care: a scoping review

Piper

Coates

2021

Implementation Sci

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Background Despite wide recognition that clinical care should be informed by the best available evidence, this does not always occur. Despite a myriad of theories, models and frameworks to promote evidence-based population health, there is still a long way to go, particularly in maternity care. The aim of this study is to appraise the scientific study of methods to promote the systematic uptake of evidence-based interventions in maternity care. This is achieved by clarifying if and how implementation science theories, models, and frameworks are used. Methods To map relevant literature, a scoping review was conducted of articles published between January 2005 and December 2019, guided by Peters and colleagues’ (2015) approach. Specifically, the following academic databases were systematically searched to identify publications that presented findings on implementation science or the implementation process (rather than just the intervention effect): Business Source Complete; CINAHL Plus with Full Text; Health Business Elite; Health Source: Nursing/Academic Edition; Medline; PsycARTICLES; PsycINFO; and PubMed. Information about each study was extracted using a purposely designed data extraction form. Results Of the 1181 publications identified, 158 were included in this review. Most of these reported on factors that enabled implementation, including knowledge, training, service provider motivation, effective multilevel coordination, leadership and effective communication—yet there was limited expressed use of a theory, model or framework to guide implementation. Of the 158 publications, 144 solely reported on factors that helped and/or hindered implementation, while only 14 reported the use of a theory, model and/or framework. When a theory, model or framework was used, it typically guided data analysis or, to a lesser extent, the development of data collection tools—rather than for instance, the design of the study. Conclusion Given that models and frameworks can help to describe phenomenon, and theories can help to both describe and explain it, evidence-based maternity care might be promoted via the greater expressed use of these to ultimately inform implementation science. Specifically, advancing evidence-based maternity care, worldwide, will require the academic community to make greater explicit and judicious use of theories, models, and frameworks. Registration Registered with the Joanna Briggs Institute (registration number not provided).

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“…An additional 28 articles were retrieved from citations, and the full texts were assessed and included in the review. A total of 80 publications were included in the final review 24–103. A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews flow diagram in figure 2 summarises the search results and screening processes for this study.…”

Section: Resultsmentioning

confidence: 99%

Scoping review of maternal and newborn health interventions and programmes in Nigeria

2022

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ObjectiveTo systematically scope and map research regarding interventions, programmes or strategies to improve maternal and newborn health (MNH) in Nigeria.DesignScoping review.Data sources and eligibility criteriaSystematic searches were conducted from 1 June to 22 July 2020 in PubMed, Embase, Scopus, together with a search of the grey literature. Publications presenting interventions and programmes to improve maternal or newborn health or both in Nigeria were included.Data extraction and analysisThe data extracted included source and year of publication, geographical setting, study design, target population(s), type of intervention/programme, reported outcomes and any reported facilitators or barriers. Data analysis involved descriptive numerical summaries and qualitative content analysis. We summarised the evidence using a framework combining WHO recommendations for MNH, the continuum of care and the social determinants of health frameworks to identify gaps where further research and action may be needed.ResultsA total of 80 publications were included in this review. Most interventions (71%) were aligned with WHO recommendations, and half (n=40) targeted the pregnancy and childbirth stages of the continuum of care. Most of the programmes (n=74) examined the intermediate social determinants of maternal health related to health system factors within health facilities, with only a few interventions aimed at structural social determinants. An integrated approach to implementation and funding constraints were among factors reported as facilitators and barriers, respectively.ConclusionUsing an integrated framework, we found most MNH interventions in Nigeria were aligned with the WHO recommendations and focused on the intermediate social determinants of health within health facilities. We determined a paucity of research on interventions targeting the structural social determinants and community-based approaches, and limited attention to pre-pregnancy interventions. To accelerate progress towards the sustainable development goal MNH targets, greater focus on implementing interventions and measuring context-specific challenges beyond the health facility is required.

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A case study of community-based distribution and use of Misoprostol and Chlorhexidine in Sokoto State, Nigeria

Cited by 7 publications

References 10 publications

Implementing at-scale, community-based distribution of misoprostol tablets to mothers in the third stage of labor for the prevention of postpartum haemorrhage in Sokoto State, Nigeria: Early results and lessons learned

Implementing at-scale, community-based distribution of misoprostol tablets to mothers in the third stage of labor for the prevention of postpartum haemorrhage in Sokoto State, Nigeria: Early results and lessons learned

Implementation science in maternity care: a scoping review

Scoping review of maternal and newborn health interventions and programmes in Nigeria

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