1. Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: Operations research study in Nepal
- Author
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Rajbhandari, Swaraj, Hodgins, Stephen, Sanghvi, Harshad, McPherson, Robert, Pradhan, Yasho V., Baqui, Abdullah H., and Misoprostol Study Group
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STIMULANTS , *COMMUNITY health services , *MISOPROSTOL , *CHILDBIRTH at home , *OPERATIONS research , *MEDICAL care , *HEMORRHAGE prevention , *PUERPERAL disorders , *OXYTOCICS , *CLINICAL trials , *COMMUNITY health workers , *COMPARATIVE studies , *DELIVERY (Obstetrics) , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *SELF medication , *SYSTEM analysis , *PILOT projects , *EVALUATION research , *PATIENTS' attitudes , *PREVENTION , *THERAPEUTICS - Abstract
Objective: To determine feasibility of community-based distribution of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant woman through community volunteers working under government health services.Methods: Implemented in one district in Nepal. The primary measure of performance was uterotonic protection after childbirth, measured using pre- and postintervention surveys (28 clusters, each with 30 households). Maternal deaths were ascertained through systematic health facility and community-based surveillance; causes of death were assigned based on verbal autopsy.Results: Of 840 postintervention survey respondents, 73.2% received misoprostol. The standardized proportion of vaginal deliveries protected by a uterotonic rose from 11.6% to 74.2%. Those experiencing the largest gains were the poor, the illiterate, and those living in remote areas.Conclusion: Community-based distribution of misoprostol for PPH prevention can be successfully implemented under government health services in a low-resource, geographically challenging setting, resulting in much increased population-level protection against PPH, with particularly large gains among the disadvantaged. [ABSTRACT FROM AUTHOR]- Published
- 2010
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