Feasibility, Acceptability, and Programme Effectiveness of Misoprostol for Prevention of Postpartum Haemorrhage in Rural Bangladesh: A Quasiexperimental Study
We explored the feasibility of distributing misoprostol tablets using two strategies in prevention of postpartum haemorrhage (PPH) among women residing in the Abhoynagar subdistrict of Bangladesh. We conducted a quasiexperimental study with a posttest design and nonequivalent comparison and intervention groups. Paramedics distributed three misoprostol tablets, one delivery mat (Quaiyum’s delivery mat), a packet of five standardized sanitary pads, and one lidded plastic container with detailed counseling on their use. All materials except misoprostol were also provided with counseling sessions to the control group participants. Postpartum blood loss was measured by paramedics using standardized method. This study has demonstrated community acceptability to misoprostol tablets for the prevention of PPH that reduced overall volume of blood loss after childbirth. Likewise, the delivery mat and pad were found to be useful to mothers as tools for assessing the amount of blood loss after delivery and informing care-seeking decisions. Further studies should be undertaken to explore whether government outreach health workers can be trained to effectively distribute misoprostol tablets among rural women of Bangladesh. Such a study should explore and identify the programmatic requirements to integrate this within the existing reproductive health program of the Government of Bangladesh. 1. Introduction Globally, postpartum haemorrhage (PPH) has been identified as one of the leading causes of maternal mortality and morbidity and approximately one-third of total maternal deaths occur in Asia [1]. We learned from both national DHS surveys [2, 3] and individual studies [4, 5] that haemorrhage has been one of the major causes of maternal deaths in Bangladesh during this last decade. PPH is unpredictable, catastrophic, and may occur even among women who are considered to be at low risk [6]. As a result, experts have concluded that the millennium development goals will not successfully be achieved without reducing deaths attributable to PPH, particularly those that occur in resource poor settings [7]. Several causes are attributable to the development of PPH, most commonly reported is uterine atony, as well as surgical incisions or lacerations and coagulation disorders [8]. Investigators of a study conducted in Pakistan identified two major causes of primary PPH: uterine atony (70.5%) and traumatic lesions of genital tract (29.4%) [9]. The investigators of this study further suggested that uterine atony was associated with augmented labor, prolonged labor, retention of
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