Community‐based distribution of misoprostol for treatment or prevention of postpartum hemorrhage: Cost‐effectiveness, mortality, and morbidity reduction analysis

Sutherland, Tori; Meyer, Carinne; Bishai, David; Geller, Stacie E.; Miller, Suellen

doi:10.1016/j.ijgo.2009.11.007

Cited by 34 publications

(43 citation statements)

References 22 publications

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“…In the Nepal study, there was a statistically significant decline in maternal mortality (98). Based on these and other data, the utilization of misoprostol for home births has the potential to reduce maternal mortality in these settings by 38-81% (121,122).…”

Section: Improvement Of Women's Healthmentioning

confidence: 82%

Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness

Perry

Zulliger

Rogers

2014

Annu. Rev. Public Health

668

671

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Over the past half-century, community health workers (CHWs) have been a growing force for extending health care and improving the health of populations. Following their introduction in the 1970s, many large-scale CHW programs declined during the 1980s, but CHW programs throughout the world more recently have seen marked growth. Research and evaluations conducted predominantly during the past two decades offer compelling evidence that CHWs are critical for helping health systems achieve their potential, regardless of a country's level of development. In low-income countries, CHWs can make major improvements in health priority areas, including reducing childhood undernutrition, improving maternal and child health, expanding access to family-planning services, and contributing to the control of HIV, malaria, and tuberculosis infections. In many middle-income countries, most notably Brazil, CHWs are key members of the health team and essential for the provision of primary health care and health promotion. In the United States, evidence indicates that CHWs can contribute to reducing the disease burden by participating in the management of hypertension, in the reduction of cardiovascular risk factors, in diabetes control, in the management of HIV infection, and in cancer screening, particularly with hard-to-reach subpopulations. This review highlights the history of CHW programs around the world and their growing importance in achieving health for all.

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Section: Improvement Of Women's Healthmentioning

confidence: 82%

Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness

Perry

Zulliger

Rogers

2014

Annu. Rev. Public Health

668

671

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show abstract

“…If TBAs could be taken on board after training could avert some of these health problems especially maternal and new-born mortality. Interventions to reduce adverse outcomes in births attended by an TBAs and other unskilled birth attendants may include, provision of oral uterotonics (Sutherland et al, 2010;Prata et al, 2011) and/or clean delivery kits (Winani et al, 2007) to mothers or postnatal home visits (Bang et al,2oo5) to identify problems.…”

Section: The Role Of Tbas On Reproductive Healthmentioning

confidence: 99%

Impact of Training traditional birth attendants on maternal mortality and morbidity in Sub-Saharan African countries

Kayombo¹

2013

Tanzania J Hlth Res

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This paper presents discussion on impact of training traditional birth attendants (TBAs) on overall improvement of reproductive health care with focus on reducing the high rate of maternal and new-born mortality in rural settings in sub-Saharan Africa. The importance of TBAs for years has been denied by professional western trained health practitioners and other scientists until during the late 1980s, when World Health Organization through Safe motherhood 1987 found TBAs have a significant role in reducing maternal and newborn mortality. Trained TBAs in sub-Sahara Africa can have positive impact on reducing maternal and new-born mortality if the programme is well implemented with systematic follow-up after training. This could be done through joint meeting between health workers and TBAs as feed and learning experience from problem encountered in process of providing child delivery services. TBAs can help to break socio-cultural barriers on intervention on reproductive health programmes. However projects targeting TBAs should not be of hit and run; but gradually familiarize with the target group, build trust, transparency, and tolerance, willing to learn and creating a better relationship with them. In this paper, some case studies are described on how trained TBAs can be fully utilized in reducing maternal and new-born mortality rate in rural areas. What is needed is to identify TBAs, map their distribution and train them on basic primary healthcare related to child deliveries and complications which need to be referred to conventional health facilities immediately.

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“…These devices are all low-cost and feasible to implement even in very low-income countries. These devices are likely to be at least as cost-effective as screening for pre-eclampsia using uterine artery Doppler and serum biomarkers [8], prophylactic magnesium sulfate for pre-eclampsia [9], community-based distribution of misoprostol for treatment or prevention of postpartum hemorrhage [23], screening for bacteriuria or syphilis, skilled birth attendance, management of obstructed labor, post-partum hemorrhage and maternal sepsis [24]. Furthermore, these devices are well within the range considered cost-effective in low-income countries based on the World Health Organization definition.…”

Section: Discussionmentioning

confidence: 99%

Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings

McLaren

Sharp

Hessburg

et al. 2017

Development Engineering

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Background Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17 percent of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs). Methods Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. Results Because the disability-adjusted life years (DALYs) averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. Conclusions Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and engineers.

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Community‐based distribution of misoprostol for treatment or prevention of postpartum hemorrhage: Cost‐effectiveness, mortality, and morbidity reduction analysis

Abstract: Both interventions were more effective at decreasing mortality and anemia than standard management. The most efficient scale-up plan would focus initially on increasing coverage with the treatment strategy ($6 per DALY).

Cited by 34 publications

References 22 publications

Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness

Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness

Impact of Training traditional birth attendants on maternal mortality and morbidity in Sub-Saharan African countries

Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings

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