Evaluation of different models of access to misoprostol at the community level to improve maternal health outcomes in Ethiopia, Ghana, and Nigeria

Wells, Elisa; Coeytaux, Francine; Azasi, Esther; Danmusa, Sada; Geressu, Takele; McNally, Tarra K; Potts, Jerald F.; Otive-Igbuzor, Ejiro; Tibebu, Senait

doi:10.1016/j.ijgo.2016.04.002

Cited by 12 publications

(43 citation statements)

References 21 publications

(25 reference statements)

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“…Seven of the studies were from Africa and the remaining seven were from Asia. Three qualitative studies [35,26,12], seven observational studies [36][37][38][39][40][41][42], and four experimental or quasi-experimental studies [43][44][45][46] were included in this review. All studies were published from 2006 to 2018.…”

Section: Data Extraction and Analysismentioning

confidence: 99%

“…Evidence also shows that most women used the misoprostol pills as instructed [39,36,44]; unused doses were returned after birth to the point of distribution; and most others either threw it away or kept it [36,42]. However, qualitative studies in Ethiopia identified, lack of trust in women's capabilities to use misoprostol correctly [12] and fear of misuse [12,26], as a problem limiting the expansion of the program.…”

Section: Misusementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Most maternal deaths occurring due to PPH are in poorly resourced facilities or outside of a health facility where there is no access to skilled obstetric care [10][11][12]. Women who deliver at home face the highest risk of PPH, as they do not benefit from the support of skilled birth attendants and are less likely to receive timely care and medications that prevent and manage PPH [12]. Evidence shows that most PPH-associated deaths could be avoided if active management of third stage of labor (AMTSL) is implemented [13], adverse outcomes and complications are prevented or managed using safe drugs in communities and facilities, and effective referral mechanisms are implemented during delivery and in the postpartum period [14].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the existing evidence, community-based distribution of misoprostol is still the least prioritized intervention in the maternal survival strategies [22-24, 18, 25]. This is due to concerns of policymakers' and practitioners' [21,17,25,12] that misoprostol distribution at community level might decrease facility deliveries, possibly lead to misuse of misoprostol (including taking the drug before delivery, and using the drug for the purpose of inducing abortion), and lack of technologies and expertise to diagnose multiple pregnancies before using it at community levels in resourcelimited settings [20,26]. A range of other barriers at the health system, community, and policy levels are also impeding access to misoprostol for prevention of PPH.…”

Section: Introductionmentioning

confidence: 99%

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

Tiruneh

Yakob

Ayele

et al. 2019

Preprint

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KEYWORDScommunity-based distribution, diversion of facility birth, facility delivery, misoprostol 2 Abstract Introduction : Community distribution of misoprostol to pregnant women in advance of labor is one of the compelling strategies for preventing postpartum hemorrhage. Concerns have been reported that misoprostol distribution could reduce facility delivery or lead to misuse of the medication. This scoping review was conducted to synthesize the evidence on the effect of community-based misoprostol distribution on rates of facility delivery, and to assess the frequency of mothers taking distributed misoprostol before delivery, and any harmful outcomes of such misuse. Methods: We included peer-reviewed articles on misoprostol implementation from PubMed, Cochrane Review Library, Popline, and Google Scholars. Narrative synthesis was used to analyze and interpret the findings, in which quantitative and qualitative syntheses are integrated. Results: Three qualitative studies, seven observational studies, and four experimental or quasi-experimental studies were included in this study. All before-after household surveys reported increased delivery coverage after the intervention: ranging from 4 to 46 percentage points at the end of the intervention when compared to the baseline. The pooled analysis of experimental and quasi-experimental studies involving 7,564 women from four studies revealed that there was no significant difference in rates of facility delivery among the misoprostol and control groups OR 1.011; 95% CI: 0.906-1.129. A qualitative study among health professionals also indicated that community distribution of misoprostol for the prevention of postpartum hemorrhage is acceptable to community members and stakeholders and it is a feasible interim solution until access to facility birth increases. In the community-based distribution of misoprostol programs, self-administration of misoprostol by pregnant women before delivery was reported in less than 2% of women, among seven studies involving 11,108 mothers. Evidence also shows that most women who used misoprostol pills, used them as instructed. No adverse outcomes from misuse in either of the studies reviewed. Conclusions: The claim that community-based distribution of misoprostol would divert women who would have otherwise had institutional deliveries to have home deliveries and promote misuse of the medication are not supported with evidence. Therefore, community-based distribution of misoprostol can be an appropriate strategy for reducing maternal deaths which occur due to postpartum hemorrhages,

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Section: Data Extraction and Analysismentioning

confidence: 99%

Section: Misusementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Tiruneh

Yakob

Ayele

et al. 2019

Preprint

View full text Add to dashboard Cite

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Community-based misoprostol for the prevention of post-partum haemorrhage: A narrative review of the evidence base, challenges and scale-up

Hobday

Hulme

Belton

et al. 2017

Global Public Health

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Achieving Sustainable Development Goal targets for 2030 will require persistent investment and creativity in improving access to quality health services, including skilled attendance at birth and access to emergency obstetric care. Community-based misoprostol has been extensively studied and recently endorsed by the WHO for the prevention of post-partum haemorrhage. There remains little consolidated information about experience with implementation and scale-up to date. This narrative review of the literature aimed to identify the political processes leading to WHO endorsement of misoprostol for the prevention of post-partum haemorrhage and describe ongoing challenges to the uptake and scale-up at both policy and community levels. We review the peer-reviewed and grey literature on expansion and scale-up and present the issues central to moving forward.

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Community‐ based maternal and newborn interventions in Africa: Systematic review

Nishimwe

Mchunu

Mukamusoni³

2021

Journal of Clinical Nursing

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Aim and objectives This review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths. Background Most neonatal deaths (99%) occur in low‐ and middle‐income countries, with approximately half happening at home. In resource‐constrained settings, community‐based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub‐Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015. Methods The review includes quantitative, qualitative and mixed‐method studies, with a data‐based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist. Results The results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health. Conclusion The systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services. Relevant to the clinical practice Conceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers.

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Evaluation of different models of access to misoprostol at the community level to improve maternal health outcomes in Ethiopia, Ghana, and Nigeria

Cited by 12 publications

References 21 publications

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

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

Community-based misoprostol for the prevention of post-partum haemorrhage: A narrative review of the evidence base, challenges and scale-up

Community‐ based maternal and newborn interventions in Africa: Systematic review

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