Transcript Title of Presentation

Community-based PPH Prevention in
Bangladesh :
Scaling up Misoprostol Distribution and
Use
Dr. Nowrozy Kamar Jahan
Team Leader (PPH Prevention)
Mayer Hashi (Smiling Mother) Project
EngenderHealth Bangladesh
Background

MMR 320/100,000 live
births (BMHSMMS-2001)
Not Classified
16%

Estimated number of live
births: 3.8 million/year
(BMHSMMS-2001)
Hemorrhage
28%
Indirect
15%

Annual number of maternal
deaths:12,000

85% of deliveries occur at
home (BDHS 2007)
Other Direct
17%
Eclampsia
24%
Major Milestones for PPH Prevention

National PPH Prevention Task Force (October, 2006)

Misoprostol tablets approved for PPH prevention (May,
2008)

Guideline on Misoprostol use for PPH prevention (May,
2008)

Misoprostol Use Phase 1 Implementation plan for
piloting Misoprostol distribution and use (August 2008)
Community-level PPH Prevention Activities

First pilot at Tangail district (Nov,08 June, 09)
– Total population of eight sub-districts:
2.4 million
– Est. total # of pregnant women:
21,178

Formal evaluation of the Tangail pilot
(October, 2009)

2nd pilot at Cox’s Bazar (Nov,09 -June,
2010)
– Total population of five sub-districts:
1.3 Million
– Est. total # of pregnant women:
13,031
Activities undertaken in Tangail District
• District planning and orientation meeting
• Misoprostol training for GOB and NGO
fieldworkers and supervisors
• Orientation sessions for facility-based
service providers
• Repackaging of Misoprostol tablets
• Development of BCC materials
BCC Materials on Use of Misoprostol
Activities undertaken in Tangail district (Cont’d)

Identification and registration of
pregnant women

Counseling of pregnant women, birth
attendants and family members

Distribution of Misoprostol tablets

Follow-up of women after delivery
Summary Findings -Tangail
Summary Overview of Project Monitoring Data
Common reasons for not
taking Misoprostol:
25,000
20,000
• Women with severe anemia
19,497
believed that they did not have
sufficient blood to loose.
15,000
10,040
10,000
9,228
5,000
• Women who left the working
area after registration forgot to
take drug with them.
• Women who delivered alone at
home forgot to take the drug.
0
No. of women
registered
No. of women
No. of women
delivered at home took Misoprostol
• Some women were prevented
by TBAs or village doctors from
taking the tablets.
Summary Findings - Tangail (cont’d)
Side effects, referred cases and maternal death

0.4% (39) registered pregnant women suffered from minor
side effects (fever, shivering)

0.3% (25) registered pregnant women suffered from
complications and were referred to a hospital

Eight maternal deaths during the pilot period in the
project area
Summary Findings - Cox’s Bazar

During the period of November, 09January, 2010
– 8,201 pregnant women registered
– 3,213 registered pregnant women
received Misoprostol tablets
– 1,214 registered pregnant women
delivered at home
– 1,147 (94%) pregnant women who
delivered at home used Misoprostol
Scaling up Misoprostol Use Best Practice

The evaluation showed that Misoprostol can be safely
distributed by the trained GOB and NGO field workers

The 2 Pilots created demand for Misoprostol interventions
in other areas

Four large International organizations have started to
implement programs

The Ministry of Health and Family Welfare has shown
interest in scaling up the community based distribution
and use of Misoprostol throughout the country
Challenges

To scale-up Misoprostol for PPH prevention, the following
elements need to be addressed:
– National dose for Misoprostol
– Including Misoprostol tablets in the GOB logistics distribution
system
– Training and orientation through the government operational plan
– Marketing of Misoprostol for PPH prevention in a special packet
– Incorporation of Misoprostol reporting system in GOB MIS system