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Maternal Health Innovations_Graves_5.13.11


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Maternal Health Innovations_Graves_5.13.11

  1. 1. Protecting mothers from PPH at home births with misoprostol:From national advocacy to community-based distribution<br />Alisha Ann Graves, MPH<br />Senior Program Manager, VSI<br />1<br />
  2. 2. VSI’s approach<br />2<br />
  3. 3. The case of misoprostol<br />Misoprostol is capable of curbing maternal mortality due to postpartum hemorrhage & unsafe abortion <br /><ul><li> Effective, evidence-based intervention
  4. 4. Heat-stable, low-cost, generic tablets
  5. 5. Simple to administer without skilled attendance</li></ul>Ideal in low-resource settings & supported by international health organizations<br />3<br />
  6. 6. Key agencies have recognized the role of misoprostol in different settings to avoid maternal mortality<br />FIGO/ ICM 2006 Call to Action<br />“the different setting where women give birth…require different strategies to prevent and treat PPH.”<br />“…in home births without a skilled attendant, misoprostol may be the only technology available to control PPH.”<br />4<br />
  7. 7. Global Policy (cont.)<br />WHO Recommendations on the Prevention of PPH (2007)<br />“In the absence of AMTSL, a uterotonic drug (oxytocin or misoprostol) should be offered by a health worker* trained in its use for prevention of PPH”<br />*auxiliary nurse-midwives, community midwives, village midwives, and health visitors—if they have been specially trained, qualify<br />Update<br />WHO added misoprostol to its Model List of Essential Medicines for prevention of PPH (May 2011, unedited report)<br />-was previously included for treatment of incomplete abortion<br />5<br />
  8. 8. 2004 misoprostol registration status(Approximated)<br />Registered for postpartum hemorrhage (PPH) and treatment of incomplete abortion* <br />Registered for PPH and other ob/gyn indication*<br />Registered for PPH*<br />Registered for another ob/gyn indication (not PPH)<br />Registered for gastric ulcers only<br />*Misoprostol may or may not be registered for gastric ulcers<br />6<br />
  9. 9. 2010 misoprostol registration status<br />Last updated: August 2010<br />Registered for postpartum hemorrhage (PPH) & treatment of incomplete abortion* <br />Registered for PPH and other ob/gyn indication*<br />Registered for PPH*<br />Registered for another ob/gyn indication, not PPH*<br />Registered for gastric ulcers only<br />*Misoprostol may or may not be registered for gastric ulcers<br />7<br />
  10. 10. Government policies set level of access guidelines and public sector procurement<br />8<br />
  11. 11. Preventing PPH at home-births in Tanzaniathrough antenatal care (ANC) distribution of misoprostol<br />OPERATION RESEARCH<br />Goal: Assess the feasibility, safety, program effectiveness, and acceptability of distribution of misoprostol through ANC visits<br />Conducted in four districts of Tanzania (January - December 2009)<br />Collaborating Institutions:<br />9<br />
  12. 12. Enrollment and ANC/Delivery Characteristics<br />Enrollment<br />ANC Attendance = 12,892<br />Enrollment = 12,511 (97%)<br />Postpartum Interview = 6,735 (54% of enrolled)<br />ANC/Delivery Characteristics<br />Average number of ANC visits = 3.0<br />ANC attendance > 32 weeks = 44%<br />Health facility delivery = 67%<br />10<br />
  13. 13. Components of the ANC Distribution Program<br />Community Awareness Campaign on Birth Preparedness and PPH Prevention<br /><ul><li>Radio
  14. 14. Community meetings with CORPs and TBAs
  15. 15. Posters and Pamphlets</li></ul>Focused ANC with Misoprostol Distribution<br /><ul><li>ANC Visit
  16. 16. Education Session on PPH and Misoprostol
  17. 17. Misoprostol Distribution at > 32 weeks gestation</li></ul>Reduce PPH at Home Births<br />11<br />
  18. 18. 12<br />Program EffectivenessBirths Protected from PPH<br />n= 6,735<br />Green color = Birth protected from PPH by use of uterotonic after delivery<br />
  19. 19. SafetyCorrect Use of Misoprostol<br />Almost all 1,826 women who took misoprostol at home reported using the drug correctly:<br />Correct dose (3 tablets)= 99.5%<br />Correct route (oral) = 98%<br />13<br />
  20. 20. Women’s Acceptability<br />14<br />
  21. 21. Conclusions<br />Integration of misoprostol into existing ANC Services is: <br /><ul><li>Feasible
  22. 22. Reach of community awareness campaign to almost all women
  23. 23. High enrollment and misoprostol distribution to eligible clients
  24. 24. Safe
  25. 25. All women used misoprostol correctly at home births
  26. 26. Low report of postpartum symptoms
  27. 27. Effective
  28. 28. High comprehension of key community awareness messages
  29. 29. 88% coverage of misoprostol at home births
  30. 30. Acceptable
  31. 31. Women feel more secure and protected from PPH</li></ul>15<br />
  32. 32. Select Policy Implications<br />Scale-up within Tanzania and beyond<br />Consider other mechanisms of misoprostol distribution for self-administration<br />Misoprostol should be available in all delivery rooms<br />16<br />
  33. 33. Thank you<br />Alisha Ann Graves<br /><br />Stay connected!<br /><br />17<br />