Preventing Postpartum Hemorrhage in Tanzania
Sub-Saharan Africa accounts for approximately half of all maternal deaths each year, and in Tanzania alone, 13,000 women die annually due to pregnancy and delivery related causes. The country has an estimated MMR of 950, which is much higher than its neighboring countries, but typical of sub-Saharan Africa as a region. An estimated 3,000 mothers die each year in Tanzania from excessive bleeding following childbirth, or postpartum hemorrhage.
To save mothers’ lives by preventing postpartum hemorrhage (PPH) at home births with misoprostol tablets for women who are unable to reach a facility to deliver.
The studies: Use of Misoprostol for Treatment of Postpartum Hemorrhage
In a 2003 and 2004 in Kigoma, Tanzania we demonstrated that trained traditional birth attendants (TBAs) could safely and effectively diagnose PPH and treat with misoprostol. TBAs were trained to assess blood loss using the kanga cloth and upon diagnosis of PPH, in intervention villages to give the bleeding woman misoprostol and refer as necessary, and in control villages to refer the woman to the nearest health facility. We concluded that misoprostol is a low-cost, easy to use technology for control of PPH that may be administered easily by someone without formal medical training.
The experience of the TBAs involved in the intervention trial is unique in that they have continued to use misoprostol outside a study controlled environment (community-based use) since the intervention ended in 2004. Kigoma is one of the first communities in the world to use misoprostol for household management of PPH without the continued oversight of an outside organization. In 2007 the Bixby Cenrter, in collaboration with Venture Strategies for Health and Development (VSHD) and the Maweni Regional Hospital in Kigoma, Tanzania returned to the study areas to assess the long-term use of misoprostol to treat PPH at the community level.
Misoprostol Distribution during ANC Visits
This project distributes misoprostol tablets at antenatal care (ANC) visits to women who cannot reach a facility to deliver. ANC providers, during routine ANC care, are trained to provide an education session on birth preparedness and PPH. For women who are more than 32 weeks pregnant, ANC providers dispense misoprostol tablets and provide information on its use for prevention of PPH at home births in the event that they cannot deliver in a health facility.
In conjunction with the education that women receive at ANC visits, there is an extensive information, education, and community awareness campaign on birth preparedness and PPH prevention in project areas to bolster safe delivery messages, the importance of delivering in a facility, and women’s knowledge of misoprostol for PPH prevention in the community. The community awareness campaign includes radio messages, posters and pamphlets, and community sensitization meetings and one-on-one information sessions with women led by community health workers and traditional birth attendants.
This project will provide evidence to inform policy decision makers on the use of misoprostol at home births dispensed during ANC visits, and can serve as a model for other regions of Tanzania where most women deliver without a skilled attendant.
Publications and Factsheets
Misoprostol Distribution at Antenatal Care: Preliminary Report in Brief
The Ifakara Health Institute (IHI) partnered with the BixbyCenter and Venture Strategies Innovations to demonstrate the safety, acceptability, feasibility, and program-effectiveness of misoprostol distribution through ANC visits. The goal was to save mothers’ lives by preventing PPH with misoprostol at home births among women who are unable to reach a facility to deliver.
Community-Based Availability of Misoprostol: Is It Safe?
Ndola Prata, Godfrey Mbaruku, Amy A. Grossman, Martine Holston, Kristina Hsieh
This paper evaluates the safety and acceptability of long-term community-based use of misoprostol formanagement of postpartum hemorrhage (PPH) in home-births, by comparing deliveries with and without misoprostol use in communities of Kigoma, Tanzania. We administered a standardized survey instrument to women who delivered between August 2004 and May 2007. 940 women completed questionnaires, corresponding to 950 deliveries. Findings showed that the majority of TBAs administered misoprostol at the correct time (76%). Receipt of three or five tablets was most commonly reported (47% and 43% respectively). Misoprostol users were significantly more likely to experience shivering, high temperature, nausea, and vomiting after delivery; adjustment for gynecological history and delivery characteristics revealed no significant differences in experience of symptoms. Misoprostol was highly acceptable to all women surveyed. Misoprostol at the community level is a safe intervention
(Afr J Reprod Health 2009; 13:117-128).