Expanding uterotonic protection following childbirth through community‐based distribution of misoprostol: Operations research study in Nepal

Abstract

a b s t r a c t a r t i c l e i n f o Keywords:Community-based distribution Misoprostol Nepal Operations research Postpartum hemorrhage Self-administration Objective: To determine feasibility of community-based distribution of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant woman through community volunteers working under government health services. Methods: Implemented in one district in Nepal. The primary measure of performance was uterotonic protection after childbirth, measured using pre-and postintervention surveys (28 clusters, each with 30 households). Maternal deaths were ascertained through systematic health facility and community-based surveillance; causes of death were assigned based on verbal autopsy. Results: Of 840 postintervention survey respondents, 73.2% received misoprostol. The standardized proportion of vaginal deliveries protected by a uterotonic rose from 11.6% to 74.2%. Those experiencing the largest gains were the poor, the illiterate, and those living in remote areas. Conclusion: Community-based distribution of misoprostol for PPH prevention can be successfully implemented under government health services in a low-resource, geographically challenging setting, resulting in much increased population-level protection against PPH, with particularly large gains among the disadvantaged.

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

“…Pilot studies have been conducted in isolated areas of Nepal and Afghanistan to assess the feasibility, safety, acceptability, and coverage of uterotonic protection (promotion of uterine contraction following delivery to reduce the risk of postpartum hemorrhage) achieved by the distribution of misoprostol tablets by CHWs during the prenatal period for women to take immediately following a home delivery (98,105). In both cases, high rates of coverage of uterotonic protection were achieved (in 73% and 92% of deliveries, respectively), the intervention was safe, and patient satisfaction was high.…”

Knowledge, acceptability, and use of misoprostol for preventing postpartum hemorrhage following home births in rural Ethiopia

“…In Nepal, seventy-four percent of women who had live vaginal births at endline (604/816) received misoprostol. Among the misoprostol recipients, 26.5% (160/604) consumed no tablets [19]. Similarly, nearly 80% of the eligible women who delivered at home said that they would use the tablets in the future.…”

“…One of the tested channels of advance provision include community-based distribution of misoprostol to traditional birth attendants (TBAs) and community health workers [19] Recent literature shown in a community based distribution in the district, from January 2006 through June 2008, 18,761 women received misoprostol and related counselling; 13 969 (74.5% of those receiving misoprostol) took it. Endline survey data show that 73.2% of recently delivered women reported having received misoprostol from an Female Community Health Volunteers (FCHVs) during pregnancy [19]. In Afghanistan, ninety-two percent of all women, regardless of whether they actually took the misoprostol or not, said they would recommend misoprostol to their friends and use it in their next pregnancy.…”

“…The most plausible reason for this might be the role of community health volunteers in educating mothers regarding PPH and advantages of misoprostol application during home birth. In one pilot study, with over 13,000 women having used misoprostol , there has been little if any indication of resistance to future use because of unacceptable side effects [19]. Similarly, in Tanzania, misoprostol for PPH treatment is perceived as highly acceptable.…”

Women's Health in Women's Hands: A Pilot Study Assessing the Feasibility of Providing Women With Medications to Reduce Postpartum Hemorrhage and Sepsis in Rural Tanzania

“…Community distribution of misoprostol for PPH prevention through various providers has been demonstrated to be effective in India (Derman et al, 2006), Afghanistan , Nepal (Rajbhandari et al, 2010), Bangladesh (Nasreen, Nahar, Al Mamun, Afsana, & Byass, 2011), and Pakistan (Mir Wajid, & Gull, 2012), as well as several other countries in Africa and Asia (Smith, Gubin, Holston, Fullerton, & Prata, 2013). In Tanzania, there have been two studies of misoprostol for PPH prevention.…”