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

Swaraj Rajbhandari, Stephen Hodgins, Harshad Sanghvi, Robert McPherson, Yasho V. Pradhan, Abdullah Baqui

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)282-288
Number of pages7
JournalInternational Journal of Gynecology and Obstetrics
Volume108
Issue number3
DOIs
StatePublished - Mar 2010

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Operations Research
Postpartum Hemorrhage
Misoprostol
Nepal
Parturition
Delivery of Health Care
Health Services
Maternal Death
Health Facilities
Vulnerable Populations
Pregnant Women
Cause of Death
Volunteers
Autopsy
Population
Surveys and Questionnaires

Keywords

  • Community-based distribution
  • Misoprostol
  • Nepal
  • Operations research
  • Postpartum hemorrhage
  • Self-administration

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Expanding uterotonic protection following childbirth through community-based distribution of misoprostol : Operations research study in Nepal. / Rajbhandari, Swaraj; Hodgins, Stephen; Sanghvi, Harshad; McPherson, Robert; Pradhan, Yasho V.; Baqui, Abdullah.

In: International Journal of Gynecology and Obstetrics, Vol. 108, No. 3, 03.2010, p. 282-288.

Research output: Contribution to journalArticle

Rajbhandari, Swaraj ; Hodgins, Stephen ; Sanghvi, Harshad ; McPherson, Robert ; Pradhan, Yasho V. ; Baqui, Abdullah. / Expanding uterotonic protection following childbirth through community-based distribution of misoprostol : Operations research study in Nepal. In: International Journal of Gynecology and Obstetrics. 2010 ; Vol. 108, No. 3. pp. 282-288.
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