Abstract
BackgroundAccording to the Pakistan Demographic and Health Survey from 2006–2007, the maternal mortality ratio in rural areas is 319 per 100,000 live births. Postpartum hemorrhage is the leading cause of maternal deaths in Pakistan. The objectives of the study were to document the feasibility of distribution of misoprostol tablets by community-based providers mainly traditional birth attendants and acceptability and use of misoprostol by women who gave birth at home.MethodsA quasi-experimental design, comprising intervention and comparison areas, was used to document the acceptability of providing misoprostol tablets to pregnant women to prevent postpartum hemorrhage in the rural community setting in Pakistan. Data were collected using structured questionnaires administered to women before and after delivery at home and their birth attendants.ResultsOut of 770 women who delivered at home, 678 (88%) ingested misoprostol tablets and 647 (84%) ingested the tablets after the birth of the neonate but prior to the delivery of the placenta. The remaining women took misoprostol tablets after delivery of the placenta. Side effects were experienced by 40% of women and were transitory in nature. Among women who delivered at home, 80% said that they would use misoprostol tablets in the future and 74% were willing to purchase them in the future.ConclusionsSelf-administration of misoprostol in the home setting is feasible. Community-based providers, such as traditional birth attendants and community midwives with proper training and counseling, play an important role in reducing postpartum hemorrhage. Proper counseling and information exchange are helpful for introducing new practices in resource-constrained rural communities. Until such a time that skilled birth attendance is made more universally available in the rural setting, alternative strategies, such as training and using the services of traditional birth attendants to provide safe pregnancy care, must be considered.
Highlights
According to the Pakistan Demographic and Health Survey from 2006–2007, the maternal mortality ratio in rural areas is 319 per 100,000 live births
Results from a study in Egypt recommend the use of misoprostol, even in the hospital setting if there are staff shortages, refrigeration issues and/or high caseloads, because misoprostol offers the advantage of a one-drug regimen, stability, and easy administration, compared with injectable uterotonics [5]
The use of misoprostol has been recommended by the United States Pharmacopoeia Expert Committee for the Prevention of postpartum hemorrhage (PPH), especially in settings where injectable uterotonic drugs are not available [9]
Summary
According to the Pakistan Demographic and Health Survey from 2006–2007, the maternal mortality ratio in rural areas is 319 per 100,000 live births. Postpartum hemorrhage is the leading cause of maternal deaths in Pakistan. Among the major causes of maternal deaths, postpartum hemorrhage (PPH) is the most common. According to the Pakistan Demographic and Health Survey of 2006–2007, 27.2% of maternal deaths were caused by PPH [1]. To prevent PPH, injectable oxytocin is recommended at the time of delivery as per routine. Oxytocin requires storage in a cool temperature (5–25°C), and can only be kept outside these temperatures for short durations. A skilled provider trained in safe injection practices and the availability of sterile syringes and needles are required [2]
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