221803 Community-based Prevention of Postpartum Hemorrhage in Rural Bangladesh

Wednesday, November 10, 2010 : 11:00 AM - 11:15 AM

Ndola Prata, MD, MSc , The Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, Berkeley, CA
MA Quaiyum, MBBS, PhD , Public Health Sciences Division, ICDDR, B, Dhaka, Bangladesh
SA Shahed Hossain, MBBS, MSc, MBA , Health Systems and Infectious Disease Division, ICDDR,B, Dhaka, Bangladesh
Asrafi Jahan Azmi, Research Investigator , Health system and Infectious disease Division, ICDDR,B, Dhaka, Bangladesh
Paige Passano, MPH , Bixby Center for Population, Health, and Sustainability, School of Public Health, University of California Berkeley, Berkeley, CA
Daniel D. Bohl, MPH, MD Candidate , School of Public Health, University of California, Berkeley, Berkeley, CA
Background: In rural Bangladesh, rates of home deliveries are among the highest in the world, with 90% of women delivering at home, the vast majority without skilled attendants. Since expansion of the skilled workforce is expected to be slow, interventions are needed to reduce maternal mortality in the interim. We assessed the feasibility, acceptability, and efficacy of a community-based strategy to prevent postpartum hemorrhage, a major contributor to maternal mortality ratios in Bangladesh. Methods: 465 traditional birth attendants employed by a Bangladeshi NGO participated in a two-day training in home-based use of oral misoprostol and an absorbent mat, which indicates when a threshold of 500ml blood loss is reached. Knowledge, attitudes and practices of birth attendants were measured at baseline and tracked at three points during the study period, ending at 1 year post-implementation. 64 in-depth interviews with birth attendants complemented quantitative assessments. Results: Birth attendants' knowledge and access to misoprostol prior to the study was virtually non-existent, but immediately after the training 99% of trainees stated the correct dosage, route and timing of administration. Misoprostol and the mat were clearly welcomed by birth attendents and communities, with over 90% of women offered misoprostol and the mat electing to use both interventions. The mat provided attendents with a useful communication tool to help reduce the delay in hospital transfer decisions. Conclusions: Community-based distribution of misoprostol and a delivery mat by trained and supported traditional birth attendants is a viable way to prevent postpartum hemorrhage during home births.

Learning Areas:
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research

Learning Objectives:
By the end of the session, participants would be informed about the impact and lessons learned from a large rural intervention in Bangladesh that demonstrates the feasibility of training traditional birth attendants in misoprostol use and blood loss measurement.

Keywords: Maternal Health, Health Care Access

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: misoprostol for postpartum hemorrhage

Qualified on the content I am responsible for because: I am the project coordinator for this research project.
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.