Ndola Prata, MD, MSc, Bixby Population Program, School of Public Health, University of California, Berkeley, 1213 Tolman Hall, UC-Berkeley, Berkeley, CA 94720, 5106434284, NDOLA@BERKELEY.EDU, Martha Campbell, PhD, CEIHD, University of California, Berkeley, 717 University Hall, Berkeley, CA 94720, Malcolm Potts, MB, BChir, PhD, Bixby Professor of Population and Family Planning, University of California, Berkeley, School of Public Health, Earl Warren Hall, Berkeley, CA 94720, and Godfrey Mbaruku, MD, Maweni Regional Hospital, Ministry of Health Tanzania, Kigoma, Tanzania, Kigoma, Tanzania.

In the developing world postpartum hemorrhage is the single most important cause of maternal mortality, associated with 25% of all maternal deaths. The instability of oxytocics in tropical climates, the parenteral route of its administration, and the understaffed labor wards limit its use/availability in poor countries. Associated with these factors is the aspect that most of the deliveries take place at home, most of the times assisted by TBAs.

A study to determine whether misoprostol can be safely used by TBAs during home deliveries is undergoing in Tanzania, Nigeria, and will soon start in Ethiopia. The study uses an intervention-based approach and compares the intervention with a non-intervention control area. Using focus groups, in-depth interviews, and participatory observation, we assessed: i) TBAs’ current practices in the management of PPH; ii) how TBAs estimate blood loss; and iii) what is the “critical point of blood loss” after which additional care is required. After standardization of an estimated blood loss of more than 500ml, TBAs in the intervention areas were instructed to rectally administer 1000 micrograms of misoprostol.

Prelimiary results show that misoprostol can be safely used by TBAs as a first line of treatment for PPH, by reducing the need for secondary and tertiary level of care, and therefore maternal morbidity attributed to PPH. The results from this project will serve as a model that can be applicable in developing countries, where women deliver with the assistance of TBAs, and have also policy implications for improving delivery practices in developing countries.

Learning Objectives:

• 1. Acknowledge the role of traditional birth attendants (TBAs) in the management of postpartum hemorrhage at the household level.
• 2. Recognize the importance and benefits of providing TBAs with low cost, effective technology to control PPH at the household level.
• 3. Understand the effects of 1000 micrograms of rectally administered misoprostol in the control of PPH at the household level.

Keywords: Home Based, Maternal Morbidity

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I am employed by the organization who conducted the study