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 H. 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

Keywords

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

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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