干旱区生态环境知识资源中心

Objective To determine feasibility of commuunity-based distribution Of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant women through community volunteers working Under government health services Methods Implemented in one district in Nepal The primary measure of performance was uterotonic protection after childbirth, measured using pre- arid postintervention Surveys (28 clusters, each with 30 households) Maternal deaths were ascertained through systematic health facility arid community-based surveillance, Causes of death were assigned based oil verbal autopsy Results Of 840 postintervention survey respondents, 73 2% received misoprostol The standardized propoition of vaginal deliveries protected by a uterotonic rose from 11 6% to 74 2% Those experiencing the largest gains were the poor. the illiterate, arid those living in remote areas Conclusion Community-based distribution of misoprostol for PPH prevention can be successfully implemented under government health services in a low-resource, geographically challenging setting, resulting in much increased population-level protection against PPH, with particularily large gains among the disadvantaged (C) 2009 International Federation of Gynecology and Obstetrics Published by Elsevier Ireland Ltd All rights reserved