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Transcript of 1 Long-Term Community Use of Misoprostol Kigoma, Tanzania Ndola Prata University of California,...
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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