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Postpartum hemorrhage prevention in Nepal: a program assessment.

Swaraj Pradhan Rajbhandari1, Kamal Aryal2, Wendy R Sheldon3

  • 1Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY, 10010, USA. swarajp11@gmail.com.

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Summary

Women in Nepal are willing to use misoprostol for postpartum hemorrhage (PPH) prevention during home births. However, program challenges like stock-outs and incomplete information sharing may limit long-term impact.

Keywords:
Advance distributionHome birthMisoprostolNepalPostpartum hemorrhage

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Area of Science:

  • Maternal Health
  • Public Health Interventions
  • Pharmacological PPH Prevention

Background:

  • Nepal's Ministry of Health and Population initiated a national program in 2009 for postpartum hemorrhage (PPH) prevention during home births.
  • The program involves the advance distribution of misoprostol to pregnant women and has been scaled nationwide.
  • This study provides the first large-scale evaluation of the effectiveness of this advance misoprostol distribution program.

Purpose of the Study:

  • To assess the effectiveness of Nepal's national program for advance distribution of misoprostol for PPH prevention.
  • To evaluate women's knowledge, receipt, and use of misoprostol for PPH prevention in home birth settings.
  • To examine the supply chain and information dissemination practices related to misoprostol by Female Community Health Volunteers (FCHVs) and health facilities.

Main Methods:

  • Household interviews with 2070 women who recently gave birth in nine districts across three ecological zones.
  • Interviews with 270 Female Community Health Volunteers (FCHVs) regarding misoprostol provision.
  • Interviews with staff at 99 health facilities to assess medication stock and supply.

Main Results:

  • Only 13% of women received misoprostol in advance, and 15% received information about it.
  • Among those who received it, 87% used misoprostol for PPH prevention during home births.
  • Significant challenges included FCHV stock-outs (81%), incomplete information delivery by FCHVs (50%), and insufficient misoprostol stock at half of health facilities.

Conclusions:

  • Women in Nepal demonstrate willingness and ability to use misoprostol for PPH prevention during home births when provided.
  • Persistent supply chain issues and gaps in accurate information dissemination pose significant challenges to the program's long-term scalability and impact.
  • Further research and program adjustments are necessary to address identified challenges and enhance the effectiveness of PPH prevention efforts.