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Long-Term Community Long-Term Community Use of MisoprostolUse of Misoprostol

Kigoma, TanzaniaKigoma, Tanzania

Ndola Prata

University of California, Berkeley

Venture Strategies for Health and Development

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Long-Term Community Use of Misoprostol Study

• Evaluate the long-term use of misoprostol to treat PPH during home births, including:

– Exposure & comprehension of PPH & Miso– Use, safety and acceptability of misoprostol– Willingness to pay for misoprostol

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Interviewers Meeting the TBAs

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Qualitative data• 32 In-Depth Interviews

– Mothers: 19– TBAs: 7– Health Providers: 5

• Focus Groups– Community Leaders

(Intervention and non-Intervention)

– TBAs (Intervention and non-Intervention)

– Health Providers• Review of facility data on

referrals and adverse events• Review of community registry of

maternal deaths

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Knowledge of PPH and Misoprostol

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Intervention (N=443)

Non-intervention

(N=507)

Total (N=950)

Received PPH information

78.6% 77.7% 78.1%

Received misoprostol information

45.9% 1.0% 21.9%

Received misoprostol information-among those who took the drug (N=164)

88.4% n/a n/a

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Sources of Misoprostol Information

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Measurement of Bleeding

Intervention (N=442)

Non-intervention (N=502)

Less than 2 kangas 43.7% 67.7%

2 or more kangas 54.0% 30.9%

Don’t know/Can’t remember 2.3% 1.4%

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Use of Misoprostol among TBA assisted deliveries

Women with perceived PPH (N=201)

Women offered misoprostol(N=171)

85%

Women accepted misoprostol(N=151)

88%

Women who took misoprostol and needed to be transferred for additional interventions

(N=3)

2%

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Side Effects among those who took misoprostol (n=161)

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ReferralsIntervention

N=442

Non-intervention

N=507

Total Referrals 15(3.4%) 111 (21.9%)

Reasons for Referral (no. women)

Prolonged Labor 5 4

Excessive Bleeding 6 101

Other reasons 4 7

Reasons related to side effects 0 0

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Acceptability

Intervention

N=442

Non-intervention

N=507

Would recommend misoprostol to a friend

74.4%* 85.2%

Would take misoprostol if got PPH in future 82.8% 88.4%

Would take a drug to prevent PPH 87.1%* 93.5%

Would purchase misoprostol

82.1%* 89.7%

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“Bring more! Bring more tablets!”

– Response of a mother after the interviewer introduced himself as part of a misoprostol study

Field Notes, Martine Holston Research Assistant

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Willingness to Pay for Misoprostol

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Willingness to pay for Misoprostol

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Lessons from the field• No indication of misuse• No evidence of increased morbidity/mortality• No evidence of increased home deliveries• “Kanga” continues to be used as a tool for referral

and drug administration • Miso can effectively and safely be administered by

CHW trained in its use• Women remember PPH & miso messages• High level of acceptability and WTP

– Subsidies might be needed

• ANC: untapped resource for PPH & miso information

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AcknowledgementsMaweni Hospital, Kigoma, Tanzania

Funding & commodities procurement:

Technical assistance:

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Bixby Program in Population, Family Planning & Maternal Health

University of California, Berkeley