Transcript Using Misoprostol at Community Level

Postpartum Hemorrhage Prevention and Treatment
in Africa: Using Misoprostol at Community Level
Ndola Prata, MD, MSc
Africa Regional Meeting on Interventions for
Impact in Essential Obstetric and Newborn Care
Addis Ababa, Ethiopia
February 21-25, 2011
9/28/10
Rational for community-level prevention and
treatment of PPH with misoprostol
Disparities in maternal indicators:
– MMR
– Skilled assistance during delivery
– Access to EmOC
– Access and usefulness of ANC
There is an imperative need to address home
births with quality interventions
Interventions & Technologies for PPH Management
Intervention/ Technology
Location Where it is Used
Level of Provider
Home based life saving skills
Household
Minimally trained
Conventional Injectable
Uterotonics
Facility
Household
Skilled
skilled
Misoprostol
Facility
Household
Skilled
Minimally trained & Self
Administration
Oxytocin-Uniject
Facility
Household (?)
Skilled
Minimally trained
Anti-shock Garment
Facility
Household (for application only)
Skilled
Minimally trained (for
application only)
IV fluids and Blood
Facility
Skilled
Balloon/condom Catheter
Facility
Highly skilled
Surgical interventions
Facility
Highly skilled
WHEN AND HOW DO
WE REACH THE
WOMAN?
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PPH Prevention
PREGNANCY
DELIVERY
ANC
Health Facility
Home
TBA
PPH Prevention:
Misoprostol the “game changer”
PREGNANCY
DELIVERY
ANC
Health Facility
Community
Health
Worker
M
M
Home
M
TBA
Options to Prevent PPH using
Misoprotsol at Community Level
• During pregnancy
– ANC
– Community health worker
– Safe delivery kits
– Pharmacies; chemical sellers; community drug
keepers; patent medicine vendor
• At Home Delivery
– Community health worker
– Traditional birth attendant
PPH Prevention at the Community Level
Nigeria
TBAs &
Community
Gatekeepers
Afghanistan
Community
health volunteers
Ghana
ANC Distribution
Pakistan
Lady health
visitors
Uganda
Health Centers
3&4
Nepal
Pharmacies/
Social Marketing
Tanzania
ANC Distribution
Bangladesh
TBA & ANC
Distribution in
safe delivery kits
Zambia
ANC Distribution
Mozambique
TBA & ANC
Distribution
Ethiopia
HEW
Indonesia (not shown)
Community
health volunteers
Madagascar
Primary health
centers 1& 2
Kenya
ANC Distribution
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Distribution of Misoprostol for PPH Prevention
through Antenatal Care (ANC)
Community Awareness
Campaign on Birth
Preparedness & PPH Prevention
•Radio
•Community meetings with
CORPs and TBAs
•Posters and Pamphlets
Misoprostol Distribution at ANC
•ANC Visit
•Education Session on PPH and
Misoprostol
•Misoprostol Distribution
Reduce
PPH at
Home
Births
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Misoprostol distribution at ANC increased the
number of births protected from PPH in Kenya
N=2,890
Community distribution of misoprostol increased the
number of births protected from PPH in Zaria, Nigeria
PPH Treatment at Home Births
Critical Considerations:
– Who is present at birth?
– How will women/family get
the drug?
– When is the drug
administered? How is PPH
identified?
– Route of administration?
TBA Treatment of PPH with Misoprostol Reduced
the Need for Referrals and Interventions
Intervention (n=454)
Control (n=395)
95
100
80
60
%
40
25
19
20
19
2
0
PPH
Overall Referrals
1
Required Additional
Interventions (of those
with PPH)
Prata, Mbaruku, et al. International Journal of Gynecology and Obstetrics (2005) 90,51-55.
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Use and Effectiveness of Misoprostol for
Treatment of PPH at Community level
Women with perceived PPH (2 kangas soaked with blood)
(N=239)
Women offered misoprostol for treatment
(N=171)
71.5%
Women received misoprostol for treatment
(N=164)
95.9%
Women who took misoprostol and needed to be
transferred for additional interventions
(N=3)
1.8%
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Strategies for Community level use of Misoprostol
Programatic & Implementation level
• Know the community
• Effective awareness
campaign
• Integrate misoprostol
distribution into
existing communitybased maternal health
interventions
• Improve services in
delivery rooms
Strategies for Community level use of Misoprostol
Policy Level
• Commitment to protect all deliveries from PPH
wherever they occur
• Allocation of human and financial resources
• Scale up interventions
• Work towards a comprehensive package of
maternal health services that includes
community-based distribution of misoprostol
Thank You