Nigeria

A mother and her baby in Zaira, Nigeria. Sixty five percent of Nigerian women deliver without a skilled birth attendant, putting them at increased risk of postpartum hemorrhage. Working with the Population and Reproductive Health Partnership (PRHP) of Ahmadu Bello University, Zaria, Nigeria, and Venture Strategies Innovations (VSI) the Bixby Center is researched the safety of misoprostol administered by traditional birth attendants (TBAs) at home births to prevent postpartum hemorrhage.

The need:
In Nigeria only 35% of births are attended by a skilled health provider.  Women who deliver without a skilled provider have an increased risk of dying in childbirth, most frequently from postpartum hemorrhage (PPH), the leading cause of maternal death.  In the case of Nigeria, the risks to mothers are high; a Nigerian woman has a 1 in 18 lifetime risk of maternal death.  Fifty nine thousand  (59,000) Nigerian women die from pregnancy related causes each year.

The goal:
To save mothers’ lives by preventing postpartum hemorrhage in home births with misoprostol tablets for women who are unable to reach a facility to deliver. 

The study:
The Population and Reproductive Health Partnership (PRHP) of Ahmadu Bello University, Zaria, Nigeria, collaborated with the Bixby Center and Venture Strategies Innovations (VSI) on a study to provide empirical evidence to inform policy decision-makers on the safety of misoprostol administered by traditional birth attendants (TBAs) at home births to prevent postpartum hemorrhage. 

The study was cross-sectional and descriptive in design and sought to describe community-level distribution, knowledge, acceptance and uptake of misoprostol at home births in five communities (Unguwan Godo and Hayin Ojo in Sabon Gari Local Government Area (LGA), Dakace in Zaria LGA, and Tsibiri and Yakawada in Giwa LGA).

The study includes community awareness campaigns about birth preparedness and the prevention of postpartum hemorrhage, as well as misoprostol distribution through drug keepers, TBAs and community-oriented resource persons.

Woman in Zaria in a hijab designed with misoprostol community awareness campaign messages.

Woman in Zaria wearing a hijab designed with misoprostol community awareness campaign messages.

The specific objectives include:

  • to determine the acceptability of misoprostol for the prevention of PPH
  • to identify and test the feasibility and effectiveness of distribution outlets and persons administering the drug to women at the community level
  • to document any symptoms that may be associated with the use of the drug
  • to explore issues relating to sustainability of community distribution of misoprostol
  • Based upon the available data, the study concluded that misoprostol at the community level is a feasible, safe, effective, and acceptable intervention by the community.

    Download the policy brief: Prevention of Postpartum Hemorrhage at Home Births in Five Communities around Zaria, Kaduna State, Nigeria