In a 2003 and 2004 Venture Strategies for Health and Development sponsored a study in Kigoma, Tanzania led by Dr Godfrey Mbaruku with technical assistance from Dr Ndola Prata of the Bixby team that demonstrated that trained traditional birth attendants (TBAs) could safely and effectively diagnose postpartum hemorrhage (PPH) and treat it with misoprostol. TBAs were trained to assess blood loss after delivery using the kanga cloth, (the colorful, rectangular, cotton garment all women own), and upon diagnosis of PPH TBAs in the intervention villages gave the bleeding woman misoprostol and refered them as necessary, and in control villages the TBA referred the woman to the nearest health facility. By using the Kanga as a measure to diagnose PPH, this research built on existing practices, which proved simple to adapt. Even though the Kanga methods does not give a perfect measurement, it is more accurate than most clinical estimations.
This research showed that misoprostol can be safely used by TBAs as a first line of treatment for PPH in home births, and reduce the need for secondary and tertiary level of care, and reduce maternal morbidity associated with PPH. Results show a sharp reduction in referrals given similar levels of PPH incidence. Of the 454 women in the intervention and 395 in the control, fewer than 2% of PPH cases in the intervention area were referred, compared with 19% in the control areas. Treatment of PPH at the household level by TBAs was safe. Side effects were reported, but none of the cases required specific treatment. The results were published in the International Journal of Gynaecology and Obstetrics. Read the full article Controlling postpartum hemorrhage after home births in Tanzania