217986 Protecting Women Who Deliver at Home from PPH with Misoprostol: Distribution of Misoprostol through Antenatal Care in Tanzania

Tuesday, November 9, 2010

Ndola Prata, MD, MSc , The Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, Berkeley, CA
Godfrey Mbaruku, MD, PhD , Ifakara Health Institute, Dar es Salaam, Tanzania
Martine Holston, MPH , Venture Strategies Innovations, Venture Strategies Innovations, Berkeley, CA
Albert Kitumbo, MD , Ifakara Health Institute, Dar es Salaam, Tanzania
Nuriye Nalan Sahin-Hodoglugil, MD, MA, DrPH , Venture Strategies Innovations, Berkeley, CA
New strategies to prevent postpartum hemorrhage (PPH) for women who deliver at home are urgently needed in low-resource settings. Antenatal care (ANC) is one possible mechanism for misoprostol distribution: in Tanzania, 94% of women receive antenatal care yet 53% of deliveries take place at home.

This presentation provides an overview of operations research conducted in four districts of Tanzania. During routine ANC care, providers emphasize facility delivery but also educate women on using misoprostol for PPH prevention, and dispense misoprostol to women > 32 weeks gestation for use at home births if they cannot go to a health facility for delivery. In addition, a community education campaign on birth preparedness and PPH prevention was ongoing in project areas to increase awareness of the importance of safe delivery. To date, 4,829 participants enrolled in the study, of whom only 2,529 took misoprostol home from ANC (52%) due to the gestational age requirement. Misoprostol coverage at home deliveries was high (91%), resulting in an additional 35% of births “protected” that otherwise would have been vulnerable to PPH. There was no significant decrease in health facility birth rates. All women who used misoprostol after a home delivery used it correctly. Acceptability of misoprostol was very high among women. This project demonstrated that distribution of misoprostol to pregnant women during ANC was safe, feasible and effective to provide PPH prophylaxis for home deliveries. Policy makers in Tanzania and other countries with high rates of home deliveries should scale-up misoprostol distribution at ANC.

Learning Areas:
Administer health education strategies, interventions and programs
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
1. Review the structure of misoprostol distribution during antenatal care (ANC) visits, including educating women on safe delivery messages and on the use of misoprostol at home births. 2. Understand the results of the operations research, including feasibility (e.g. coverage of misoprostol distribution at ANC visits, coverage of the community awareness campaign),;effectiveness (e.g. coverage of misoprostol at home births, coverage of “protected births”, comprehension of community awareness messages); safety (e.g. correct use of misoprostol at home births, referrals); and acceptability of misoprostol amongst women. 3. Discuss the policy implications of this research, including recommendations and challenges for implementing a country-wide distribution of misoprostol during ANC.

Keywords: Maternal Health, Safe Mother Program

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Associate Medical Director of Venture Strategies Innovations, which conducted this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.