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

Ndola Prata, Suzanne Bell, Md A. Quaiyum

Research output: Contribution to journalArticle

Abstract

Background: Bangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh.Methods: Using data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions.Results: Using project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births.Conclusion: This theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further reduce maternal mortality at home births.

Original languageEnglish (US)
Article number78
JournalBMC Pregnancy and Childbirth
Volume14
Issue number1
DOIs
StatePublished - Feb 20 2014
Externally publishedYes

Fingerprint

Postpartum Hemorrhage
Misoprostol
Bangladesh
Maternal Mortality
Live Birth
Maternal Death
Parturition
Feasibility Studies
Risk Reduction Behavior
Cause of Death

Keywords

  • Bangladesh
  • Delivery mat
  • Maternal mortality
  • Misoprostol
  • Monte Carlo
  • Postpartum hemorrhage
  • Traditional birth attendant

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Modeling maternal mortality in Bangladesh : The role of misoprostol in postpartum hemorrhage prevention. / Prata, Ndola; Bell, Suzanne; Quaiyum, Md A.

In: BMC Pregnancy and Childbirth, Vol. 14, No. 1, 78, 20.02.2014.

Research output: Contribution to journalArticle

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abstract = "Background: Bangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh.Methods: Using data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69{\%}), no (0{\%}), low (40{\%}), and high (80{\%}) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions.Results: Using project level misoprostol coverage (69{\%}), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0{\%}), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40{\%}), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80{\%}), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births.Conclusion: This theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further reduce maternal mortality at home births.",
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KW - Monte Carlo

KW - Postpartum hemorrhage

KW - Traditional birth attendant

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