Implementation of community based advance distribution of misoprostol in Himachal Pradesh (India): lessons and way forward

Abstract

BackgroundPostpartum Hemorrhage remains the leading cause of maternal mortality. To prevent PPH, Misoprostol tablet in a dose of 600 micrograms is recommended for use immediately after childbirth in home deliveries wherein the use of oxytocin is difficult. The current article describes an implementation of “community based advance distribution of Misoprostol program” in India which aimed to design an operational framework for implementing this program.MethodsThe intervention was carried out in Janjheli block in Mandi district of the state of Himachal Pradesh which is a mountainous terrain with limited geographical access and reported 90% home deliveries in the year 2014–15. An operational framework to implement program activities was designed which was based on WHO HSS building blocks. Key implementing steps included- Ensuring local ownership through program leadership, forecasting and procurement of 600 mcg misoprostol tablets, training, branding and communication, community engagement and counselling, recording and reporting, monitoring, supportive supervision and feedback mechanisms.ResultsOver the one year of implementation, 512 home deliveries were reported, out of which 89% received the tablets and 84% consumed the tablet within one minute of delivery. No incidence of PPH in tablet consuming mothers was reported. On account of periodic counselling and effective community engagement the intervention also contributed to better tracking of pregnancies till delivery and institutional delivery rates which increased to 93% from 45% and 57% from 11% respectively as compared to the preceding year.ConclusionsThe model has successfully shown the use of single misoprostol tablets of 600 mcg, first time in this program. We also demonstrated a HSS based operational framework, based on which the program is being scaled to additional blocks in Himachal Pradesh as well as to other states of India.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2036-2) contains supplementary material, which is available to authorized users.

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

“…points in Afghanistan [35], 39% points in Ghana [34], and 46% points in India [39] at the end of the intervention when compared to the baseline (Figure 2). A qualitative study among health professionals in Laos also indicated that community distribution of misoprostol, for the prevention of PPH, is acceptable to community members and stakeholders and it is a feasible interim solution until access to facility birth is improved.…”

“…Seven of the studies were from Africa and the remaining seven were from Asia. Three qualitative studies [33,25,12], seven observational studies [34][35][36][37][38][39][40], and four experimental or quasi-experimental studies [41][42][43][44] were included in this review. All studies were published from 2006 to 2018.…”

“…Ten studies (five observational before-after studies, four experimental or quasi-experimental trials, and one qualitative study) reported on the impact on facility birth as the outcome [36,37,41,35,42,34,39,33,43,44]. All five before-after household surveys reported increased facility delivery coverage after the intervention: four percentage points increase in Nepal [37] and Liberia [36], 11%…”

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

“…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.…”

“…Ten studies (five observational before-after studies, four experimental or quasi-experimental trials, and one qualitative study) reported on the impact on facility birth as the outcome [38,39,37,36,41,35,[43][44][45][46]. All five before-after household surveys reported increased facility delivery coverage after the intervention: four percentage points increase in Nepal [39] and Liberia [38], 11% points in Afghanistan [37], 39% points in Ghana [36], and 46% points in India [41] at the end of the intervention when compared to the baseline (Figure 2).…”