Transcript Field Evaluation of Community-Based Use of Misoprostol in

Long-Term Community
Use of Misoprostol
Kigoma, Tanzania
Ndola Prata
University of California, Berkeley
Venture Strategies for Health and Development
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Long-Term Community
Use of Misoprostol Study
• Evaluate the long-term use of misoprostol to
treat PPH during home births, including:
– Exposure & comprehension of PPH & Miso
– Use, safety and acceptability of misoprostol
– Willingness to pay for misoprostol
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Study Population
Births between August 2004 and May 2007
n = 3519
Intervention Area
Births
n = 1829
Non-intervention Area
Births
n = 1690
Sample Population
Questionnaires
Administered
n = 449
Sample Population
Questionnaires
Administered
n = 509
Completed
Questionnaires
n = 443
Completed
Questionnaires
n = 507
Interviewers Meeting the TBAs
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Qualitative data
• 32 In-Depth Interviews
– Mothers: 19
– TBAs: 7
– Health Providers: 5
• Focus Groups
– Community Leaders
(Intervention and nonIntervention)
– TBAs (Intervention and nonIntervention)
– Health Providers
• Review of facility data on
referrals and adverse events
• Review of community registry of
maternal deaths
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Knowledge of PPH and
Misoprostol
Intervention
(N=443)
Received PPH
information
Received
misoprostol
information
Received
misoprostol
information-among
those who took the
drug (N=164)
NonTotal
intervention (N=950)
(N=507)
78.6%
77.7%
78.1%
45.9%
1.0%
21.9%
88.4%
n/a
n/a
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Sources of Misoprostol
Information
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Measurement of Bleeding
Intervention
(N=442)
Less than 2 kangas
Nonintervention
(N=502)
43.7%
67.7%
2 or more kangas
54.0%
30.9%
2.3%
1.4%
Don’t know/Can’t remember
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Use of Misoprostol among TBA assisted
deliveries
Women with perceived PPH
(N=201)
Women offered misoprostol
(N=171)
85%
Women accepted misoprostol
(N=151)
88%
Women who took misoprostol and needed to
be transferred for additional interventions
(N=3)
2%
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Side Effects among those who took
misoprostol (n=161)
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Referrals
Intervention
N=442
Total Referrals
15(3.4%)
Nonintervention
N=507
111 (21.9%)
Reasons for Referral (no. women)
Prolonged Labor
5
4
Excessive Bleeding
6
101
Other reasons
4
7
Reasons related to side effects
0
0
11
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Acceptability
Intervention
N=442
Nonintervention
N=507
Would recommend
misoprostol to a friend
74.4%*
85.2%
Would take misoprostol if
got PPH in future
82.8%
88.4%
Would take a drug to
prevent PPH
87.1%*
93.5%
Would purchase
misoprostol
82.1%*
89.7%
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“Bring more! Bring
more tablets!”
– Response of a
mother after the
interviewer
introduced himself
as part of a
misoprostol study
Field Notes, Martine Holston
Research Assistant
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Willingness to Pay for Misoprostol
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Willingness to pay for Misoprostol
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Lessons from the field
•
•
•
•
No indication of misuse
No evidence of increased morbidity/mortality
No evidence of increased home deliveries
“Kanga” continues to be used as a tool for referral
and drug administration
• Miso can effectively and safely be administered
by CHW trained in its use
• Women remember PPH & miso messages
• High level of acceptability and WTP
– Subsidies might be needed
• ANC: untapped resource for PPH & miso
information
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Acknowledgements
Maweni Hospital, Kigoma, Tanzania
Funding & commodities procurement:
Technical assistance:
Bixby Program in Population, Family Planning & Maternal Health
University of California, Berkeley
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