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Africa Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care

Postpartum Hemorrhage Prevention and Treatment in Africa: Using Misoprostol at Community Level Ndola Prata , MD, MSc. Africa Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care Addis Ababa, Ethiopia February 21-25, 2011.

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Africa Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care

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  1. Postpartum Hemorrhage Prevention and Treatment in Africa: Using Misoprostol at Community LevelNdola Prata, MD, MSc Africa Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care Addis Ababa, Ethiopia February 21-25, 2011

  2. Rational for community-level prevention and treatment of PPH with misoprostol Disparities in maternal indicators: • MMR • Skilled assistance during delivery • Access to EmOC • Access and usefulness of ANC There is an imperative need to address home births with quality interventions

  3. Interventions & Technologies for PPH Management

  4. When and how do we reach the woman?

  5. PPH Prevention PREGNANCY DELIVERY ANC Health Facility Home TBA

  6. PPH Prevention: Misoprostol the “game changer” PREGNANCY DELIVERY ANC Health Facility M Community Health Worker Home M M TBA

  7. Options to Prevent PPH using Misoprotsol at Community Level • During pregnancy • ANC • Community health worker • Safe delivery kits • Pharmacies; chemical sellers; community drug keepers; patent medicine vendor • At Home Delivery • Community health worker • Traditional birth attendant

  8. PPH Prevention at the Community Level Nigeria TBAs & Community Gatekeepers Afghanistan Community health volunteers Pakistan Lady health visitors Ghana ANC Distribution Uganda Health Centers 3 & 4 Nepal Pharmacies/Social Marketing Bangladesh TBA & ANC Distribution in safe delivery kits Tanzania ANC Distribution Zambia ANC Distribution Ethiopia HEW Mozambique TBA & ANC Distribution Indonesia (not shown) Community health volunteers Madagascar Primary health centers 1& 2 Kenya ANC Distribution

  9. Distribution of Misoprostol for PPH Prevention through Antenatal Care (ANC) • Community Awareness Campaign on Birth Preparedness & PPH Prevention • Radio • Community meetings with CORPs and TBAs • Posters and Pamphlets • Misoprostol Distribution at ANC • ANC Visit • Education Session on PPH and Misoprostol • Misoprostol Distribution Reduce PPH at Home Births 9

  10. Misoprostol distribution at ANC increased the number of births protected from PPH in Kenya N=2,890

  11. Community distribution of misoprostol increased the number of births protected from PPH in Zaria, Nigeria

  12. PPH Treatment at Home Births Critical Considerations: • Who is present at birth? • How will women/family get the drug? • When is the drug administered? How is PPH identified? • Route of administration?

  13. TBA Treatment of PPH with Misoprostol Reduced the Need for Referrals and Interventions Prata, Mbaruku, et al. International Journal of Gynecology and Obstetrics (2005) 90,51-55.

  14. Use and Effectiveness of Misoprostol for Treatment of PPH at Community level Women with perceived PPH (2 kangas soaked with blood) (N=239) Women offered misoprostol for treatment (N=171) 71.5% Women received misoprostol for treatment (N=164) 95.9% Women who took misoprostol and needed to be transferred for additional interventions (N=3) 1.8%

  15. Strategies for Community level use of MisoprostolProgramatic & Implementation level Know the community Effective awareness campaign Integrate misoprostol distribution into existing community-based maternal health interventions Improve services in delivery rooms

  16. Strategies for Community level use of MisoprostolPolicy Level • Commitment to protect all deliveries from PPH wherever they occur • Allocation of human and financial resources • Scale up interventions • Work towards a comprehensive package of maternal health services that includes community-based distribution of misoprostol

  17. Thank You

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