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Addressing Postpartum Hemorrhage with Misoprostol in African Communities

Learn about using misoprostol at the community level to prevent and treat postpartum hemorrhage in Africa, addressing disparities in maternal indicators. Explore strategies for effective use and distribution of misoprostol, reducing the need for referrals and interventions.

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Addressing Postpartum Hemorrhage with Misoprostol in African Communities

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  1. Postpartum Hemorrhage Prevention and Treatment in Africa: Using Misoprostol at Community LevelNdola Prata, MD, MSc Africa Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care Addis Ababa, Ethiopia February 21-25, 2011

  2. Rational for community-level prevention and treatment of PPH with misoprostol Disparities in maternal indicators: • MMR • Skilled assistance during delivery • Access to EmOC • Access and usefulness of ANC There is an imperative need to address home births with quality interventions

  3. Interventions & Technologies for PPH Management

  4. When and how do we reach the woman?

  5. PPH Prevention PREGNANCY DELIVERY ANC Health Facility Home TBA

  6. PPH Prevention: Misoprostol the “game changer” PREGNANCY DELIVERY ANC Health Facility M Community Health Worker Home M M TBA

  7. Options to Prevent PPH using Misoprotsol at Community Level • During pregnancy • ANC • Community health worker • Safe delivery kits • Pharmacies; chemical sellers; community drug keepers; patent medicine vendor • At Home Delivery • Community health worker • Traditional birth attendant

  8. PPH Prevention at the Community Level Nigeria TBAs & Community Gatekeepers Afghanistan Community health volunteers Pakistan Lady health visitors Ghana ANC Distribution Uganda Health Centers 3 & 4 Nepal Pharmacies/Social Marketing Bangladesh TBA & ANC Distribution in safe delivery kits Tanzania ANC Distribution Zambia ANC Distribution Ethiopia HEW Mozambique TBA & ANC Distribution Indonesia (not shown) Community health volunteers Madagascar Primary health centers 1& 2 Kenya ANC Distribution

  9. Distribution of Misoprostol for PPH Prevention through Antenatal Care (ANC) • Community Awareness Campaign on Birth Preparedness & PPH Prevention • Radio • Community meetings with CORPs and TBAs • Posters and Pamphlets • Misoprostol Distribution at ANC • ANC Visit • Education Session on PPH and Misoprostol • Misoprostol Distribution Reduce PPH at Home Births 9

  10. Misoprostol distribution at ANC increased the number of births protected from PPH in Kenya N=2,890

  11. Community distribution of misoprostol increased the number of births protected from PPH in Zaria, Nigeria

  12. PPH Treatment at Home Births Critical Considerations: • Who is present at birth? • How will women/family get the drug? • When is the drug administered? How is PPH identified? • Route of administration?

  13. TBA Treatment of PPH with Misoprostol Reduced the Need for Referrals and Interventions Prata, Mbaruku, et al. International Journal of Gynecology and Obstetrics (2005) 90,51-55.

  14. Use and Effectiveness of Misoprostol for Treatment of PPH at Community level Women with perceived PPH (2 kangas soaked with blood) (N=239) Women offered misoprostol for treatment (N=171) 71.5% Women received misoprostol for treatment (N=164) 95.9% Women who took misoprostol and needed to be transferred for additional interventions (N=3) 1.8%

  15. Strategies for Community level use of MisoprostolProgramatic & Implementation level Know the community Effective awareness campaign Integrate misoprostol distribution into existing community-based maternal health interventions Improve services in delivery rooms

  16. Strategies for Community level use of MisoprostolPolicy Level • Commitment to protect all deliveries from PPH wherever they occur • Allocation of human and financial resources • Scale up interventions • Work towards a comprehensive package of maternal health services that includes community-based distribution of misoprostol

  17. Thank You

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