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

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• 作者：Jeffrey Michael Smith (4)
  Saye Dahn Baawo (5)
  Marion Subah (6)
  Varwo Sirtor-Gbassie (7)
  Cuallau Jabbeh Howe (5)
  Gbenga Ishola (8)
  Bentoe Z Tehoungue (5)
  Vikas Dwivedi (9)
  
  4. MCHIP ; Jhpiego ; 1776 Massachusetts Ave. ; NW#300 ; Washington ; DC ; 20036 ; USA
  5. Ministry of Health and Social Welfare ; Monrovia ; Republic of Liberia
  6. Jhpiego/Liberia ; Monrovia ; Republic of Liberia
  7. MCHIP/Liberia ; Monrovia ; Republic of Liberia
  8. Jhpiego/Nigeria ; Abuja ; Republic of Liberia
  9. MCHIP/JSI Research & Training ; Inc ; Boston ; MA ; 02210 ; USA
  
• 关键词：Advance distribution ; Misoprostol ; Postpartum hemorrhage ; Uterotonic ; Coverage ; CHW ; AMTSL ; Home birth ; Liberia
• 刊名：BMC Pregnancy and Childbirth
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：568 KB
• 参考文献：Trends in Maternal Mortality: 1990 to 2008.
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  Liberia Demographic and Health Survey.
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  4. Caliskan, E, Dilbaz, B, Meydali, MM, Ozturk, N, Narin, MA, Haberal, A (2003) Oral Misoprostol for the third stage of labor: a randomized trial. Obstet Gynecol 101: pp. 921-928
  5. Alfirevic, Z, Blum, J, Walraven, G, Weeks, A, Winikoff, B (2007) Prevention of postpartum hemorrhage with misoprostol. Int J Obstet Gynaecol 99: pp. S198-S201
  6. el-Refaey, H, O'Brien, P, Morafa, W, Walder, J, Rodeck, C (1997) Use of oral misoprostol in the prevention of postpartum hemorrhage. Br J ObstetGynaecol 104: pp. 336-339 CrossRef
  7. McCormick, ML, Sanghvi, HCG, Kinzie, B, McIntosh, N (2002) Averting maternal death and disability: Prevention postpartum hemorrhage in low-resource settings. Int J Obstet Gynaecol 77: pp. 267-275 CrossRef
  8. Smith, JM, Gubin, R, Holston, MM, Fullerton, J, Prata, N (2013) Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date. BMC Pregnancy Childbirth 13: pp. 44 CrossRef
  9. Ejembi, CL, Norick, P, Starrs, A, Thapa, K (2013) New global guidance supports community and lay health workers in postpartum hemorrhage prevention. Int J Gynecol Obstet 122: pp. 187-190 CrossRef
  10. Hundley, VA, Avan, BI, Sullivan, CJ, Graham, WJ (2013) Should oral misoprostol be used to prevent postpartum haemorrhage in home-birth settings in low-resource countries? A systematic review of the evidence. Br J Obstet Gynecol 120: pp. 277-285 CrossRef
  11. Lori, JR, Boyle, JS (2011) Cultural childbirth practices, beliefs and traditions in postconflict Liberia. Health Care Women Int 32: pp. 454-473 CrossRef
  12. Rajbhandari, S, Hodgins, S, Sanghvi, H, McPherson, R, Pradhan, YV, Baqui, AH (2010) Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: operations research study in Nepal. Int J Gynecol Obstet 108: pp. 282-288 CrossRef
  13. Sanghvi, H, Ansari, N, Prata, NJ, Gibson, H, Ehsan, AT, Smith, JM (2010) Prevention of postpartum hemorrhage at home birth in Afghanistan. Int J Gynaecol Obstet 108: pp. 276-281 CrossRef
  14. Geller, S, Carnahan, L, Akosah, E, Asare, G, Agyemang, R, Dickson, R, Kapungu, C, Owusu-Ansah, L, Robinson, N, Mensah-Homiah, J (2014) Community-based distribution of misoprostol to prevent postpartum haemorrhage at home births: results from operations research in rural Ghana. BJOG 121: pp. 319-326 CrossRef
  15. Derman, RJ, Kodkany, BS, Goudar, SS, Geller, SE, Naik, VA, Bellad, MB, Patted, SS, Patel, A, Edlavitch, SA, Hartwell, T, Chakraborty, H, Moss, N (2006) Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet 368: pp. 1248-1253 CrossRef
  16. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2393/14/189/prepub
  
• 刊物主题：Reproductive Medicine; Maternal and Child Health; Gynecology;
• 出版者：BioMed Central
• ISSN：1471-2393

文摘

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.