Community-based Distribution of Misoprostol towards the Prevention of Postpartum Hemorrhage: Drug Efficacy and Factors Associated with Misoprostol Ingestion in Doti District, Nepal

Abstract

The Objective of the current study was to understand the factors associated with misoprostol ingestion among Recently Delivered Women (RDW) and Examine the association of misoprostol ingestion with the prevention of postpartum hemorrhage in the selected population in Doti District, Nepal, as part of CARE’s CRADLE project. Descriptive study (Design) with applying bivariate and multivariate analysis. The population of interest included all women in Doti District who had delivered a baby within the last year. The study was conducted in Doti District in the Far Western Region of Nepal. Doti’s is primarily a rural district and its terrain is hilly to mountainous and in some areas it abuts the terai. Significant tracts of the district are remote and unlinked by roads.  A total of 345 women were surveyed. Data was collected on all of the 345 RDW for demographic background, their maternal health practices, their knowledge of misoprostol in the prevention of PPH, their receipt and timing of ingestion of misoprostol tablets. Of these 345 women 181 received Misoprostol tablet and 164 did not. The main outcome measure included: socio-demographic information of mothers, place of delivery, Antenatal care visits, received misoprostol tablets in last pregnancy, correctly ingested misoprostol tablets, experiences of post-partum haemorrhage (PPH). Roughly half of the sample, 50.1%, is 25 years of age or older, a slight majority of women were illiterate, 54.2%, consistent with other surveys done by project and 56.5% identify as being a member of a non- dalit caste. The dalit caste (name for umbrella group of lower castes).  Almost all women, 98.6%, delivered at home. While  modeling the results for prevention of postpartum hemorrhage and modeled results for ingestion of misoprostol  towards the prevention of PPH, study found that ingestion of 600 µg of misoprostol in the third stage of labor was significantly associated with the prevention of PPH, Counseling on the birth preparedness plan by a Female Community Health Volunteers (FCHV) in women’s eighth month of pregnancy was associated with a 53.7% reduction in PPH, there is a positive relationship between literacy and ingestion; literate women were 1.4 times more likely to ingest MSC tablets relative to women who are not, and Strong associations exist between the knowledge of the number of MSC tablets to take, ANC visits and MSC ingestion. The study shows the effectiveness of Misoprostol in the prevention of PPH at the community level distributed by female community health volunteers in a remote hilly to mountainous district and is thus scale able in other hilly/mountainous areas of Nepal. Out of 181 women who received Misoprostol  169 consumed (93%).  Only four out of 181 women 0.02% did not take the correct dose and took a lower dose.  No women took the dose at the wrong time. The MOH program on incentivizing the presence of FCHV at birth is complementary and can enhance the receipt and consumption of Misoprostol leading to lowered incidence of PPH and PPH related deaths.