Assessing strategies for distribution of misoprostol at community level and its uptake for prevention of postpartum hemorrhage in two semi-urban communities in Kaduna State, Northwestern Nigeria

Abstract

Introduction: This study assessed two strategies for distribution of misoprostol using identified and trained community persons (village heads) and distribution in a Primary Health Care (PHC) facility during antenatal visits and its uptake for the prevention of postpartum hemorrhage (PPH) in two semi-urban communities in Sabon-Gari Local Government Area of Kaduna State, Northwest Nigeria. Materials and Methods: Using a quasi-experimental study design, two semi-urban communities, Hayin Dogo and Basawa, in Sabon-Gari LGA of Kaduna State were selected, and each was assigned either of the two misoprostol distribution methods using balloting. At baseline, 300 women who had delivered within 6 months of onset of the study were sampled in the two communities using multistage sampling technique. Using structured, interviewer-administered questionnaires, information was collected on their knowledge of PPH, misoprostol and its uptake after delivery. This was followed by communication interventions, mainly through community dialogues to raise awareness and create demand for misoprostol, identification, and training of traditional birth attendants (TBAs) and drug keepers in the two communities and positioning of the drug in the PHC center in Hayin Dogo and at community level in Basawa community. Subsequently, all the 320 deliveries in the two communities that occurred during the 6 months following intervention were identified at endline and the same questionnaire administered to the women. A monitoring phase was carried out for 6 months in between the pre- and postintervention where 284 deliveries in Hayin Dogo and Basawa communities were monitored whether they used or did not use misoprostol during home births. Results: Respondents knowledge significantly improved from 2.0% at baseline to 7.1% postintervention in Hayin Dogo (χ2 = 4.7; df = 1; P 0.05). The educational level of the women had a greater influence on their use of misoprostol. Conclusion: There was an increase in knowledge of prevention and treatment of PPH. The intervention led to significant increase in the use of misoprostol, but the method of distribution did not significantly affect the uptake of the drug. Both strategies are feasible for distributing misoprostol for increasing its use at home deliveries.