Advance Distribution of Misoprostol for Prevention of Postpartum Hemorrhage in South Sudan

Publish Date: November 2014
Author: Jeffrey Smith, Alexander Dimiti, Vikas Dwivedi, Isabella Ochieng, Maryrose Dalaka, Sheena Currie, Edward Eremugo Luka, John Rumunu, Solomon Orero, Jaime Mungia, and Catharine McKaig
Language: English

This MCHIP co-authored article in the International Journal of Gynecology & Obstetrics describes the results of a study to evaluate whether a facility- and community-focused postpartum hemorrhage (PPH) prevention program in one county in South Sudan achieved high uterotonic coverage of all births. Under this program, PPH prevention and management were strengthened at health facilities, and advance distribution of misoprostol for PPH prevention at home births was offered to pregnant women around 32 weeks gestation during antenatal care and home visits.

Data were collected through facility registers by providers, home visits by home health promoters and postpartum interviews by external data collectors. Findings showed that from September 2012 to March 2013, 927 deliveries were reported (533 at home and 394 in facilities). Misoprostol was distributed in advance to 787 (85.2%) pregnant women, primarily during home visits (82.8%). Among enrolled women who delivered at home, 98.9% reported taking the drug. A uterotonic for PPH prevention was provided in 86.8% of facility deliveries. Total uterotonic coverage for all births was 93.7%. No adverse events were reported.

The authors conclude that it is feasible to achieve high coverage of uterotonic use in a low-resource and post-conflict setting with few skilled birth attendants through a combination of advance distribution and active management of the third stage of labor at facilities. Advance distribution through home visits was key to achieving high coverage of misoprostol use.

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