Dr. Nowrozy Kamar JahanTeam Leader (PPH Prevention)

Mayer Hashi (Smiling Mother) Project

EngenderHealth Bangladesh

Community-based PPH Prevention in Community-based PPH Prevention in

Bangladesh : Bangladesh :

Scaling up Misoprostol Distribution and Scaling up Misoprostol Distribution and

UseUse

Background

MMR 320/100,000 live births (BMHSMMS-2001BMHSMMS-2001)

Estimated number of live births: 3.8 million/year (BMHSMMS-BMHSMMS-

20012001)

Annual number of maternal deaths:12,000

85% of deliveries occur at home (BDHS 2007)

Eclampsia24%

Indirect15%

Not Classified 16%

Hemorrhage 28%

Other Direct 17%

National PPH Prevention Task Force (October, 2006)

Misoprostol tablets approved for PPH prevention (May, 2008)

Guideline on Misoprostol use for PPH prevention (May, 2008)

Misoprostol Use Phase 1 Implementation plan for piloting Misoprostol distribution and use (August 2008)

Major Milestones for PPH Prevention

First pilot at Tangail district (Nov,08 - June, 09)

– Total population of eight sub-districts: 2.4 million

– Est. total # of pregnant women: 21,178

Formal evaluation of the Tangail pilot (October, 2009)

2nd pilot at Cox’s Bazar (Nov,09 -June, 2010)

– Total population of five sub-districts: 1.3 Million

– Est. total # of pregnant women: 13,031

Community-level PPH Prevention Activities

• District planning and orientation meeting

• Misoprostol training for GOB and NGO fieldworkers and supervisors

• Orientation sessions for facility-based service providers

• Repackaging of Misoprostol tablets

• Development of BCC materials

Activities undertaken in Tangail District

BCC Materials on Use of Misoprostol

Activities undertaken in Tangail district (Cont’d)

Identification and registration of pregnant women

Counseling of pregnant women, birth attendants and family members

Distribution of Misoprostol tablets

Follow-up of women after delivery

Summary Findings -Tangail

19,497

10,040 9,228

0

5,000

10,000

15,000

20,000

25,000

No. of womenregistered

No. of womendelivered at home

No. of womentook Misoprostol

Summary Overview of Project Monitoring DataCommon reasons for not taking Misoprostol: • Women with severe anemia believed that they did not have sufficient blood to loose.

• Women who left the working area after registration forgot to take drug with them.

• Women who delivered alone at home forgot to take the drug.

• Some women were prevented by TBAs or village doctors from taking the tablets.

Summary Findings - Tangail (cont’d)

Side effects, referred cases and maternal

death 0.4% (39) registered pregnant women suffered

from minor side effects (fever, shivering)

0.3% (25) registered pregnant women suffered from complications and were referred to a hospital

Eight maternal deaths during the pilot period in the project area

Summary Findings - Cox’s Bazar

During the period of November, 09- January, 2010

– 8,201 pregnant women registered

– 3,213 registered pregnant women received Misoprostol tablets

– 1,214 registered pregnant women delivered at home

– 1,147 (94%) pregnant women who delivered at home used Misoprostol

Scaling up Misoprostol Use Best Practice

The evaluation showed that Misoprostol can be safely distributed by the trained GOB and NGO field workers

The 2 Pilots created demand for Misoprostol interventions in other areas

Four large International organizations have started to implement programs

The Ministry of Health and Family Welfare has shown interest in scaling up the community based distribution and use of Misoprostol throughout the country

Challenges

To scale-up Misoprostol for PPH prevention, the following elements need to be addressed:

– National dose for Misoprostol

– Including Misoprostol tablets in the GOB logistics distribution system

– Training and orientation through the government operational plan

– Marketing of Misoprostol for PPH prevention in a special packet

– Incorporation of Misoprostol reporting system in GOB MIS system