Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention

Prata, Ndola; Bell, Suzanne O.; Quaiyum, Abdul

doi:10.1186/1471-2393-14-78

Cited by 24 publications

(31 citation statements)

References 30 publications

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“…The maternal and newborn care received is also related to delivery location (Murthy et al, 2007). In some developing countries, a large proportion of women have non-institutional delivery (Prata et al, 2014). A study from Ethiopia found institutional delivery service utilization was 38.1% (Ababulgu & Bekuma, 2016).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Non-Institutional Delivery among Pregnant Women in Nepal

Tamang¹,

McNeil²,

Tongkumchum³

2019

ASS

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Delivery location may influence maternal morbidity and mortality, especially in developing countries such as Nepal. The aim of this study was to determine factors associated with place of delivery among pregnant women in Nepal in order to inform health policy makers attempting to improve mother and child health. Data from the Multiple Indicator Cluster Survey, conducted in 2014, were retrospectively reviewed. In the survey, women aged 15-49 years were interviewed face-to-face using a structured questionnaire. Study subjects were women who had giving birth within the previous two years. A total of 2,086 women (48.9%) had non-institutional delivery (46.5% at home). Logistic regression models were used to identify significant factors influencing non-institutional delivery. Results showed that increasing educational level and wealth quintile index corresponded to a decreasing percentage of non-institutional delivery. More than half (55.5%) of women from rural areas had a non-institutional delivery. Multiparous women (57.2%) and those having less than 4 antenatal care visits (66.8%) had relatively higher rates of non-institutional delivery. In conclusion, there is a need to intensify education for pregnant women, especially those who have had previous childbirth experience. It is also crucial to target women from poor households, to increase their awareness, and promote institutional delivery.

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Section: Introductionmentioning

confidence: 99%

Factors Associated with Non-Institutional Delivery among Pregnant Women in Nepal

Tamang¹,

McNeil²,

Tongkumchum³

2019

ASS

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“…They found a total of 108 lives saved per 100,000 women delivering at home, using misoprostol for PPH prevention, in a setting where there are an estimated 130 PPH-attributable deaths per 100,000 live births. In a more recent modeling study based on Bangladesh data[ 247 ], with current maternal mortality ratio (MMR) (approximately 200/100,000), evidence from the literature on efficacy, and cause-specific mortality in their study population, the authors determined that with “high coverage” of 80%, using misoprostol after home births approximately 13 deaths could be averted per 100,000 live births (i.e. about 6% lower than current mortality).…”

Section: Resultsmentioning

confidence: 99%

A New Look at Care in Pregnancy: Simple, Effective Interventions for Neglected Populations

et al. 2016

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BackgroundAlthough this is beginning to change, the content of antenatal care has been relatively neglected in safe-motherhood program efforts. This appears in part to be due to an unwarranted belief that interventions over this period have far less impact than those provided around the time of birth. In this par, we review available evidence for 21 interventions potentially deliverable during pregnancy at high coverage to neglected populations in low income countries, with regard to effectiveness in reducing risk of: maternal mortality, newborn mortality, stillbirth, prematurity and intrauterine growth restriction. Selection was restricted to interventions that can be provided by non-professional health auxiliaries and not requiring laboratory support.MethodsIn this narrative review, we included relevant Cochrane and other systematic reviews and did comprehensive bibliographic searches. Inclusion criteria varied by intervention; where available randomized controlled trial evidence was insufficient, observational study evidence was considered. For each intervention we focused on overall contribution to our outcomes of interest, across varying epidemiologies.ResultsIn the aggregate, achieving high effective coverage for this set of interventions would very substantially reduce risk for our outcomes of interest and reduce outcome inequities. Certain specific interventions, if pushed to high coverage have significant potential impact across many settings. For example, reliable detection of pre-eclampsia followed by timely delivery could prevent up to ¼ of newborn and stillbirth deaths and over 90% of maternal eclampsia/pre-eclampsia deaths. Other interventions have potent effects in specific settings: in areas of high P falciparum burden, systematic use of insecticide-treated nets and/or intermittent presumptive therapy in pregnancy could reduce maternal mortality by up to 10%, newborn mortality by up to 20%, and stillbirths by up to 25–30%. Behavioral interventions targeting practices at birth and in the hours that follow can have substantial impact in settings where many births happen at home: in such circumstances early initiation of breastfeeding can reduce risk of newborn death by up to 20%; good thermal care practices can reduce mortality risk by a similar order of magnitude.ConclusionsSimple interventions delivered during pregnancy have considerable potential impact on important mortality outcomes. More programmatic effort is warranted to ensure high effective coverage.

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“… Conducted phased trial Obstetric Gynecology Society of Bangladesh (OGSB) Published in peer reviewed journals Misoprostol was included in the program of activities for community health workers and family welfare agents Government Departments - DGHS, Drug Administration Provided technical assistance NGOs-BRAC, Pathfinder International, Engender Health, UN Agencies Researcher’s efforts to promote utilization of study findings “We took a temporary permission from the Drug Administration of Bangladesh to conduct the research and subsequently, after we found that it is effective and useful for prevention of PPH and in collaboration with the drug companies and the pharmaceutical licensure of Bangladesh we requested them to extend the registration of the use of misoprostol for the prevention of PPH and we informed them that we will provide all the papers and any technical assistance they need and they did it and now misoprostol is registered in Bangladesh for use of in the prevention of PPH and that’s happened because of our research findings” (KII001) Case study 2. Enactment of the Bangladesh Domestic Relations Bill 2010 Characteristics of the study Factors that could have contributed to research utilization Activities to promote utilization Utilization of research findings Policy contribution Study/Authors/years Study design/ population Main findings Research Process (Problem identification) Stakeholder involvement Communication Process Macro-contextual factors Asling-Monemi K, Tabassum Naved R, Perrsson LA, 2008 [ 31 ] Secondary analysis of longitudinal data from rural Bangladesh of 2691 live-born children in relation to their mother's experience of physical, sexual and emotional partner violence and level of controlling behaviour in marriage. Under five-mortality was 88 per 1000 in this cohort.…”

Section: Resultsmentioning

confidence: 99%

Utilization of research findings for health policy making and practice: evidence from three case studies in Bangladesh

Walugembe

Kiwanuka

Matovu

et al. 2015

Health Res Policy Sys

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BackgroundIn striving to contribute towards improved health outcomes, health research institutions generate and accumulate huge volumes of relevant but often underutilized data. This study explores activities undertaken by researchers from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), an international research institution that promotes the utilization of their findings in the policymaking processes in Bangladesh.MethodsThe study used an exploratory case study design and employed qualitative methods to explore activities implemented to promote research utilization and the extent to which researchers felt that their findings contributed to the policymaking process. Data were collected between September and December 2011 through key informant interviews, focus group discussions with study investigators, and database and document reviews. We reviewed findings from 19 reproductive health studies conducted and completed by icddr,b researchers between 2001 and 2011. We interviewed 21 key informants, including 13 researchers, two policy makers, and six programme implementers. Data were entered into Microsoft Word and analyzed manually following a thematic framework approach. Following the World Health Organization/Turning Research into Practice (WHO/TRIP) framework, three case studies of how research findings were utilized in the policymaking processes in Bangladesh were documented.ResultsActivities implemented to promote research utilization included conducting dissemination workshops, publishing scientific papers, developing policy briefs, providing technical assistance to policymakers and programme implementers, holding one-on-one meetings, and joining advocacy networks. The majority of the researchers (12 of 13) reported that their study findings were utilized to influence policymaking processes at different levels. However, some researchers reported being unaware of whether and how their findings were utilized. As regards actual utilization of research findings, the evidence from the three case studies indicate that research findings can be utilized instrumentally, conceptually and symbolically, and at different stages within the policymaking process, including agenda setting and policy formulation and implementation.ConclusionsThe results show that research findings from icddr,b were promoted and utilized in health policymaking processes in Bangladesh using a variety of utilization approaches. These results suggest a need for using multiple approaches to promote utilization of research findings in health policymaking processes.

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Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention

Cited by 24 publications

References 30 publications

Factors Associated with Non-Institutional Delivery among Pregnant Women in Nepal

Factors Associated with Non-Institutional Delivery among Pregnant Women in Nepal

A New Look at Care in Pregnancy: Simple, Effective Interventions for Neglected Populations

Utilization of research findings for health policy making and practice: evidence from three case studies in Bangladesh

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