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Citation Information

Type Journal Article - International Journal of Gynecology & Obstetrics
Title Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: operations research study in Nepal
Author(s)
Volume 108
Issue 3
Publication (Day/Month/Year) 2010
Page numbers 282-288
URL http://www.ncbi.nlm.nih.gov/pubmed/20034628
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.

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