Jeffrey M Smith1, Alexander Dimiti2, Vikas Dwivedi3, Isabella Ochieng4, Maryrose Dalaka5, Sheena Currie6, Edward Eremugo Luka4, John Rumunu7, Solomon Orero4, Jaime Mungia8, Catharine McKaig4. 1. Maternal and Child Health Integrated Program, Jhpiego, Washington DC, USA. Electronic address: jeffrey.smith@jhpiego.org. 2. Ministry of Health, Government of South Sudan, Juba, South Sudan. 3. Maternal and Child Health Integrated Program, JSI Research and Training Institute, Washington DC, USA. 4. Integrated Service Delivery Project, Jhpiego, Juba, South Sudan. 5. Mundri Relief and Development Association, Juba, South Sudan. 6. Maternal and Child Health Integrated Program, Jhpiego, Washington DC, USA. 7. International Finance Corporation, Juba, South Sudan. 8. Jhpiego, Baltimore, MD, USA.
Abstract
OBJECTIVE: To determine if high uterotonic coverage can be achieved in South Sudan through a facility- and community-focused postpartum hemorrhage (PPH) prevention program. METHODS: The program was implemented from October 2012 to March 2013. At health facilities, active management of the third stage of labor (AMTSL) was emphasized. During prenatal care and home visits, misoprostol was distributed to pregnant women at approximately 32 weeks of pregnancy for the prevention of PPH at home births. Data on uterotonic coverage and other program outcomes were collected through facility registers, home visits, and postpartum interviews. RESULTS: In total, 533 home births and 394 facility-based births were reported. Misoprostol was distributed in advance to 787 (84.9%) pregnant women, of whom 652 (82.8%) received the drug during home visits. Among the women who delivered at home, 527 (98.9%) reported taking misoprostol. A uterotonic for PPH prevention was provided at 342 (86.8%) facility-based deliveries. Total uterotonic coverage was 93.7%. No adverse events were reported. CONCLUSION: It is feasible to achieve high coverage of uterotonic use in a low-resource and postconflict setting with few skilled birth attendants through a combination of advance misoprostol distribution and AMTSL at facilities. Advance distribution through home visits was key to achieving high coverage of misoprostol use.
OBJECTIVE: To determine if high uterotonic coverage can be achieved in South Sudan through a facility- and community-focused postpartum hemorrhage (PPH) prevention program. METHODS: The program was implemented from October 2012 to March 2013. At health facilities, active management of the third stage of labor (AMTSL) was emphasized. During prenatal care and home visits, misoprostol was distributed to pregnant women at approximately 32 weeks of pregnancy for the prevention of PPH at home births. Data on uterotonic coverage and other program outcomes were collected through facility registers, home visits, and postpartum interviews. RESULTS: In total, 533 home births and 394 facility-based births were reported. Misoprostol was distributed in advance to 787 (84.9%) pregnant women, of whom 652 (82.8%) received the drug during home visits. Among the women who delivered at home, 527 (98.9%) reported taking misoprostol. A uterotonic for PPH prevention was provided at 342 (86.8%) facility-based deliveries. Total uterotonic coverage was 93.7%. No adverse events were reported. CONCLUSION: It is feasible to achieve high coverage of uterotonic use in a low-resource and postconflict setting with few skilled birth attendants through a combination of advance misoprostol distribution and AMTSL at facilities. Advance distribution through home visits was key to achieving high coverage of misoprostol use.
Keywords:
Active management of the third stage of labor; Advance distribution; Community health workers; Coverage; Home birth; Misoprostol; Postpartum hemorrhage prevention; Safety
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