Barriers or gaps in implementation of misoprostol use for post-abortion care and post-partum hemorrhage prevention in developing countries: a systematic review

Abstract

BackgroundAround 303,000 maternal deaths occur every year; most of these are preventable (World Health Organization), ICD-10: International classification of diseases and related health problems, 10th revision. Volume 2: Instruction manual, 2010). Ninety-nine percent of these maternal deaths occur in developing countries. PPH contributed 35 % (35%) of total maternal. Several interventions being done to reduce the number of maternal deaths. It has been noted that a simple low cost intervention of providing misoprostol timely could prevent these deaths.ObjectivesThe objectives of this systematic review was to identify barriers/gaps in the implementation of misoprostol use for prevention of postpartum hemorrhage and management of Post-abortion care services in developing countries.MethodsThis study was a systematic review of published qualitative and quantitative literature on misoprostol in developing countries. Documents included were local and international peer reviewed articles and program reports on misoprostol implementation. PubMed, Google Scholars and Science direct databases were used along with Grey literature and manual search using terms “implementation gaps”, “misoprostol use”, “postpartum hemorrhage”, “post-abortion care” and “developing countries”.ResultsGaps or barriers in misoprostol use identified through systematic review can be categorized into six broader thematic areas including: inconsistency in supplies and its distribution; inadequate staffing; lack of knowledge of providers and end users, absence of the registration of drug and fear and apprehensions related to its use at provider and policy level.ConclusionIt is concluded that barriers and gaps can be addressed through providing enabling environment through supportive policies, designing a formal plan for supplies, task shifting strategies and use of guidelines and protocols for successful implementation.Electronic supplementary materialThe online version of this article (10.1186/s12978-017-0383-5) contains supplementary material, which is available to authorized users.

Influencing Factors for Early Detection and Prevention of Postpartum Hemorrhage in The Northern Province of Rwanda: Beneficiary and Health Worker Perspectives.

“…Our results reveal that CHWs had limited knowledge about PPH prevention. This is in agreement with ndings from a recent systematic review [46] highlighting the risk associated with inconsistent community knowledge regarding dosage and timings of misoprostol use for PPH prevention, and inconsistency of CHWs' knowledge to differentiate between PPH caused by atony or due to other causes such as uterine rupture, vaginal lacerations and placental abnormalities. Educational sessions for all people involved in the prevention of PPH has been proposed as a way to contribute to early detection of PPH risk factors.…”

Influencing Factors for Prevention of Postpartum Hemorrhage and Early Detection of Women at Risk in The Northern Province of Rwanda: Beneficiary and Health Worker Perspectives

“…With regards to the prevention of PPH, our results reveal that CHWs had limited knowledge. This is in agreement with ndings from a recent systematic review [42] highlighting the risk associated with inconsistent community knowledge regarding dosage and timings of misoprostol use for PPH prevention, and inconsistency of CHWs' knowledge to differentiate between PPH caused by atony or due to other causes such as uterine rupture, vaginal lacerations and placental abnormalities. Educational sessions for all people involved in the prevention of PPH has been proposed as a way to contribute to early detection of PPH risk factors.…”

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

“…As such, community-based distribution of misoprostol programs should include the promotion of facility-based birth [4,36,35] as a critical intervention. Successful implementation of misoprostol distribution can be facilitated by creating an enabling environment through supportive policies, designing a formal plan for supplies, task shifting strategies, and appropriate use of guidelines and protocols [27]. Moreover, strong leadership and political commitment, training, and community mobilization were identified as critical success factors [20].…”

“…A range of other barriers at the health system, community, and policy levels are also impeding access to misoprostol for prevention of PPH. These barriers include: 1) absence of registration of misoprostol for the management of PPH [27,25], 2) fear and apprehensions of providers and policymakers regarding its use [27,25], 3) lack of evidence-based guidelines and provider training [25], 4) inadequate staffing and lack of knowledge and skill of providers regarding causes of PPH, and 5) limited knowledge of the community regarding the appropriate dosage and timing of administration for PPH presentation and management [27,20].…”