Uterotonic use immediately following birth: using a novel methodology to estimate population coverage in four countries

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• 作者：Jim Ricca (1)
  Vikas Dwivedi (2)
  John Varallo (1)
  Gajendra Singh (3)
  Suranjeen Prasad Pallipamula (4)
  Nazir Amade (5)
  Maria de Luz Vaz (6)
  Dustan Bishanga (7)
  Marya Plotkin (8)
  Bushra Al-Makaleh (9)
  Stephanie Suhowatsky (1)
  Jeffrey Michael Smith (1)
  
  1. Maternal and Child Survival Program ; Jhpiego ; 1776 Massachusetts Ave. ; NW #300 ; Washington ; DC ; 20036 ; USA
  2. Maternal and Child Survival Program ; JSI Research & Training Institute ; Inc ; 1776 Massachusetts Ave. ; NW #300 ; Washington ; DC ; 20036 ; USA
  3. Jhpiego ; 221 ; Okhla Phase III ; New Delhi ; 110 020 ; India
  4. Maternal Child Integrated Program (MCHIP) ; Jhpiego ; Government Vaccine Institute Campus ; Namkum ; Ranchi ; Jharkhand ; 834010 ; India
  5. Director of Maternal and Child Health ; Ministry of Health ; Maputo ; Mozambique
  6. MCHIP ; Jhpiego ; Maputo ; Mozambique
  7. MCHIP ; Jhpiego ; PO Box 9170 ; Dar es Salaam ; Tanzania
  8. Jhpiego Tanzania ; PO Box 9170 ; Dar es Salaam ; Tanzania
  9. MCHIP ; Yemen ; Haddah Street ; Sana鈥檃 City ; Yemen
  
• 关键词：Uterotonic ; Estimation ; Postpartum hemorrhage (PPH) ; Delphi method ; UUIFB
• 刊名：BMC Health Services Research
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：15
• 期：1
• 全文大小：495 KB
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• 刊物主题：Public Health; Health Administration; Health Informatics; Nursing Management/Nursing Research;
• 出版者：BioMed Central
• ISSN：1472-6963

文摘

Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in developing countries. While incidence of PPH can be dramatically reduced by uterotonic use immediately following birth (UUIFB) in both community and facility settings, national coverage estimates are rare. Most national health systems have no indicator to track this, and community-based measurements are even more scarce. To fill this information gap, a methodology for estimating national coverage for UUIFB was developed and piloted in four settings. Methods The rapid estimation methodology consisted of convening a group of national technical experts and using the Delphi method to come to consensus on key data elements that were applied to a simple algorithm, generating a non-precise national estimate of coverage of UUIFB. Data elements needed for the calculation were the distribution of births by location and estimates of UUIFB in each of those settings, adjusted to take account of stockout rates and potency of uterotonics. This exercise was conducted in 2013 in Mozambique, Tanzania, the state of Jharkhand in India, and Yemen. Results Available data showed that deliveries in public health facilities account for approximately half of births in Mozambique and Tanzania, 16% in Jharkhand and 24% of births in Yemen. Significant proportions of births occur in private facilities in Jharkhand and faith-based facilities in Tanzania. Estimated uterotonic use for facility births ranged from 70 to 100%. Uterotonics are not used routinely for PPH prevention at home births in any of the settings. National UUIFB coverage estimates of all births were 43% in Mozambique, 40% in Tanzania, 44% in Jharkhand, and 14% in Yemen. Conclusion This methodology for estimating coverage of UUIFB was found to be feasible and acceptable. While the exercise produces imprecise estimates whose validity cannot be assessed objectively in the absence of a gold standard estimate, stakeholders felt they were accurate enough to be actionable. The exercise highlighted information and practice gaps and promoted discussion on ways to improve UUIFB measurement and coverage, particularly of home births. Further follow up is needed to verify actions taken. The methodology produces useful data to help accelerate efforts to reduce maternal mortality.