Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: Operations research study in Nepal

<bold>Objective: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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]