Abstract
BackgroundBangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh.MethodsUsing data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions.ResultsUsing project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births.ConclusionThis theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further reduce maternal mortality at home births.
Highlights
Bangladesh is one of the few countries that may achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low
The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) at home births in Bangladesh
Based on the number of maternal deaths, we calculated overall and cause specific maternal mortality ratio (MMR) for the project and compared these to the expected MMRs based on the Bangladesh Maternal Mortality Survey (BMMS) data (Table 3)
Summary
Bangladesh is one of the few countries that may achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. TBAs that attend these births typically do not have appropriate technologies to manage or treat complications, which explains many studies’ findings that TBA trainings are not effective at improving maternal survival [9]. Despite these discouraging findings, research has shown that approximately 80% of maternal deaths are due to avoidable causes, among which hemorrhage is a leading cause [10,11]. PPH poses a significant public health challenge in low-resource settings because of its low predictability [15] and the speed at which it kills; without intervention, 88% of women who die of postpartum hemorrhage die within four hours of delivery [16]
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