Duration: 2009 – 2011
Donor: Venture Strategies Innovations (VSI)
Project Contact: Prof. Zahida Qureshi
Postpartum hemorrhage (PPH), or excessive bleeding after childbirth, is among the leading causes of maternal death in Kenya, and globally. Over half (55%) of deliveries in Kenya take place at home, many without a skilled attendant, meaning current interventions that can prevent or treat PPH are out of reach for these women. Misoprostol tablets are safe, effective and affordable, and have been proven to reduce postpartum bleeding. Misoprostol is recommended jointly by FIGO/ICM as the only available technology to control life-threatening PPH during home births without a skilled attendant. Since almost all Kenyan women (92%) utilize antenatal care (ANC) services during pregnancy, reaching pregnant women with misoprostol tablets at ANC visits could be a key strategy for increasing protection from PPH in the most vulnerable populations. In addition, equipping Kenya’s cadre of Community Midwives with misoprostol can help fill the gap of uterotonic coverage for women unable to reach a facility to deliver.
In 2009, the Division of Reproductive Health within the Ministry of Public Health and Sanitation (MOPHS) of Kenya, in collaboration with the Kenya Obstetrical and Gynaecological Society (KOGS) and Venture Strategies Innovations (VSI), initiated a pilot project to demonstrate that distribution of misoprostol through ANC and at delivery with Community Midwives (CMs), complemented by an education campaign, are appropriate strategies for increasing protection against PPH in the context of Kenya’s health system. The pilot project took place in two districts, Kitui and Maragua, and aimed to contribute to a reduction in maternal mortality and morbidity by increasing access to uterotonic drugs for the prevention of PPH, as well as to provide empirical evidence to inform policy in Kenya on the use of misoprostol for PPH at the community level.
“Use MISO after birth to protect the mother’s life”
The project included a community awareness campaign on birth preparedness, PPH and the use of misoprostol for PPH prevention. Posters and pamphlets containing these messages were displayed in ANC facilities and distributed by Community Health Workers (CHWs). CHWs also communicated these key safe motherhood messages through conducting group awareness-raising meetings and one-on-one education sessions with women.
Distribution of misoprostol at the community level
The project also included distribution of misoprostol. ANC providers distributed misoprostol to pregnant women attending ANC at all ANC facilities in Kitui and Maragua districts after screening the women for eligibility and educating them on the proper use of misoprostol. In Maragua district, CMs could also provide misoprostol to women at the time of delivery.
Community health workers essential in communicating safe delivery messages
CHWs conducted over 3,700 community sensitization meetings about misoprostol, reaching approximately 23,500 people across Kitui and Maragua districts.
High coverage of misoprostol distribution to eligible women
The overwhelming majority (98%) of women enrolled in the project during ANC took misoprostol home with them.
Women continued to deliver in health facilities
There was no significant change in the proportion of women delivering at a health facility due to the introduction of misoprostol distribution for home deliveries.
More births protected from PPH
Of the women who delivered at home in both districts, 95% used misoprostol at delivery. These deliveries would otherwise not have received any uterotonic coverage against PPH. Overall,
misoprostol use protected over 60% of births in Kitui and 35% of births in Maragua against PPH.
Women used misoprostol correctly at home births
Women used misoprostol at home deliveries correctly 97% of the time: correct dose (100%), route (100%) and timing (97%).
DISSEMINATION OF THE PILOT PROJECT RESULTS
On Thursday, 17 March 2011, KOGS and VSI presented the final results of this pilot project to the MOPHS and maternal health stakeholders at a dissemination meeting in Nairobi. Following the supportive recommendations shared there by stakeholders, the final results were presented on 5 April 2011 to the provincial heads and leadership within both the MOPHS and the Ministry of Medical Services.
Key Recommendations from the project results dissemination meetings:
At dissemination meetings in each project district, project beneficiaries shared their experiences using misoprostol for PPH prevention.
Below are some of their experiences;
|“I used miso that I had received at the antenatal clinic when I delivered my baby Joseph on the road. When the baby came, I was on the way to the health facility with two community health workers. I had my miso and took the tablets. I shivered a bit but when I was covered with a blanket, I recovered quickly. This being my third born, I was worried I would bleed because I bled a lot during my previous deliveries. I have seen the goodness of miso. This time I didn’t bleed.”– Jacinta, mother from Maragua district|
|“This was my third pregnancy and in my previous deliveries, I would bleed for some time. When I came to the clinic, I was advised on miso and I went home with the tablets and I told my mother about them. During the delivery, my mother gave me the tablets and I was surprised that I didn’t have any bleeding. Miso should continue. It is a very good drug.” – Agnes, mother from Kitui district|