Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia

Jeffrey Smith, Saye D. Baawo, Marion Subah, Varwo Sirtor-Gbassie, Cuallau J. Howe, Gbenga Ishola, Bentoe Z. Tehoungue, Vikas Dwivedi

Research output: Contribution to journalArticle

Abstract

Background: A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated.Methods: Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction.Results: There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program.Conclusions: The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not receive education or advance distribution of misoprostol. A revised community-based strategy is needed to increase advance distribution rates and misoprostol coverage rates for home births. Misoprostol for PPH prevention appears acceptable to women in Liberia. Correct timing of misoprostol self-administration needs improved emphasis during counseling and education.

Original languageEnglish (US)
Article number189
JournalBMC Pregnancy and Childbirth
Volume14
Issue number1
DOIs
StatePublished - Jun 4 2014
Externally publishedYes

Fingerprint

Liberia
Postpartum Hemorrhage
Misoprostol
Parturition
Prenatal Care
House Calls
Reproductive Health
Oxytocin
Education
Postpartum Period
Self Administration
Birth Rate
Midwifery

Keywords

  • Advance distribution
  • AMTSL
  • CHW
  • Coverage
  • Home birth
  • Liberia
  • Misoprostol
  • Postpartum hemorrhage
  • Uterotonic

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia. / Smith, Jeffrey; Baawo, Saye D.; Subah, Marion; Sirtor-Gbassie, Varwo; Howe, Cuallau J.; Ishola, Gbenga; Tehoungue, Bentoe Z.; Dwivedi, Vikas.

In: BMC Pregnancy and Childbirth, Vol. 14, No. 1, 189, 04.06.2014.

Research output: Contribution to journalArticle

Smith, Jeffrey ; Baawo, Saye D. ; Subah, Marion ; Sirtor-Gbassie, Varwo ; Howe, Cuallau J. ; Ishola, Gbenga ; Tehoungue, Bentoe Z. ; Dwivedi, Vikas. / Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia. In: BMC Pregnancy and Childbirth. 2014 ; Vol. 14, No. 1.
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title = "Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia",
abstract = "Background: A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated.Methods: Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction.Results: There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7{\%}) were enrolled and provided misoprostol, primarily through ANC (78.2{\%}). Uterotonic coverage rate of all deliveries was 53.5{\%}, based on 97.7{\%} oxytocin use at recorded facility vaginal births and 24.9{\%} misoprostol use at home births. Among 550 women interviewed postpartum, 87.7{\%} of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0{\%}) took it at the correct time, and 54.0{\%} experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program.Conclusions: The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3{\%} of expected deliveries did not receive education or advance distribution of misoprostol. A revised community-based strategy is needed to increase advance distribution rates and misoprostol coverage rates for home births. Misoprostol for PPH prevention appears acceptable to women in Liberia. Correct timing of misoprostol self-administration needs improved emphasis during counseling and education.",
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AU - Baawo, Saye D.

AU - Subah, Marion

AU - Sirtor-Gbassie, Varwo

AU - Howe, Cuallau J.

AU - Ishola, Gbenga

AU - Tehoungue, Bentoe Z.

AU - Dwivedi, Vikas

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N2 - Background: A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated.Methods: Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction.Results: There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program.Conclusions: The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not receive education or advance distribution of misoprostol. A revised community-based strategy is needed to increase advance distribution rates and misoprostol coverage rates for home births. Misoprostol for PPH prevention appears acceptable to women in Liberia. Correct timing of misoprostol self-administration needs improved emphasis during counseling and education.

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