Abstract
BackgroundPostpartum Hemorrhage remains the leading cause of maternal mortality. To prevent PPH, Misoprostol tablet in a dose of 600 micrograms is recommended for use immediately after childbirth in home deliveries wherein the use of oxytocin is difficult. The current article describes an implementation of “community based advance distribution of Misoprostol program” in India which aimed to design an operational framework for implementing this program.MethodsThe intervention was carried out in Janjheli block in Mandi district of the state of Himachal Pradesh which is a mountainous terrain with limited geographical access and reported 90% home deliveries in the year 2014–15. An operational framework to implement program activities was designed which was based on WHO HSS building blocks. Key implementing steps included- Ensuring local ownership through program leadership, forecasting and procurement of 600 mcg misoprostol tablets, training, branding and communication, community engagement and counselling, recording and reporting, monitoring, supportive supervision and feedback mechanisms.ResultsOver the one year of implementation, 512 home deliveries were reported, out of which 89% received the tablets and 84% consumed the tablet within one minute of delivery. No incidence of PPH in tablet consuming mothers was reported. On account of periodic counselling and effective community engagement the intervention also contributed to better tracking of pregnancies till delivery and institutional delivery rates which increased to 93% from 45% and 57% from 11% respectively as compared to the preceding year.ConclusionsThe model has successfully shown the use of single misoprostol tablets of 600 mcg, first time in this program. We also demonstrated a HSS based operational framework, based on which the program is being scaled to additional blocks in Himachal Pradesh as well as to other states of India.
Highlights
Postpartum Hemorrhage remains the leading cause of maternal mortality
A major concern for prevention of Post-Partum Hemorrhage (PPH) is that the administration of oxytocin, requires the assistance of a skilled birth attendant (SBA), and is not available to women experiencing unattended home births, either by choice, lack of access to SBAs [6, 7] or due to gender and wealth disparities [8,9,10].To address these concerns as regards uterotonic cover, the use of misoprostol for the prevention of PPH by community health care workers and lay health workers is recommended in settings where skilled birth attendants are not present [5]
Of the total 1265 deliveries reported, misoprostol was distributed to 979 women who were identified for possible home deliveries
Summary
Postpartum Hemorrhage remains the leading cause of maternal mortality. To prevent PPH, Misoprostol tablet in a dose of 600 micrograms is recommended for use immediately after childbirth in home deliveries wherein the use of oxytocin is difficult. In line with the global scenario hemorrhage accounts for 40% maternal deaths in India with Post-Partum Hemorrhage (PPH) being the major contributor [4] Recognizing this important fact, the use of Uterotonics immediately after birth has been universally advocated to prevent the occurrence of PPH [5]. A major concern for prevention of PPH is that the administration of oxytocin, requires the assistance of a skilled birth attendant (SBA), and is not available to women experiencing unattended home births, either by choice, lack of access to SBAs [6, 7] or due to gender and wealth disparities [8,9,10].To address these concerns as regards uterotonic cover, the use of misoprostol for the prevention of PPH by community health care workers and lay health workers is recommended in settings where skilled birth attendants are not present [5]. Multiple programs across the globe have been implemented using misoprostol for prevention of PPH in home births using different approaches [13] and it is widely recognized that distribution of misoprostol through community health workers (CHWs) for PPH prevention could be a significant step in reducing maternal deaths in low-resource settings [14]
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