TRAINING INFORMAL CARE PROVIDERS TO PREVENT BLEEDING AFTER CHILDBIRTH THROUGH THE USE OF MISOPROSTOL.

TRAINING INFORMAL CARE PROVIDERS TO PREVENT BLEEDING AFTER CHILDBIRTH THROUGH THE USE OF MISOPROSTOL.
Maternal mortality(MM) is a major health problem in Africa which records the highest rate in the world. In Nigeria, an estimated 55,000 women die yearly during pregnancy and childbirth. This can be likened to about one air-bus crash with an estimated 177 passengers on board per day. This tells about the magnitude of MM in Nigeria which is the second worst in the world trailing india.
A significantly higher proportion of the deaths occur in rural as compared to urban communities with maternal bleeding following delivery [primary postpartum haemorrhage (PPH)] a leading cause accounting for more than 25%. In order to make child birth a safe and satisfying experience for the mother, baby and her relatives, appropriate management of the first few hours that follow the birth of the baby is essential. Adherence to this strategy has been scientifically proven to prevent severe maternal bleeding after childbirth and reduce MM when uterine atony occurs.
The causes of many maternal deaths, which occur more in rural areas, are unsupervised deliveries usually with untrained informal care providers [Traditional Birth Attendants (TBAs) & Faith Based Healers]. Presently, many of these care providers have not been trained to use injectable Oxytocin or Ergometrine recommended as first or second line drugs respectively by the World Health Organisation (WHO) to prevent and treat uterine atony that leads to PPH. Thus in settings like ours where most deliveries are attended by TBAs, who do not have necessary capacity to safely administer injectable drugs, there is a need to train these informal maternity care providers and scale simple interventions like oral Misoprostol which is a safe and effective alternative to traditional injectable drugs used in preventing and treating maternal bleeding in the immediate period following childbirth.
As an Obstetrician-Gynaecologist concerned with preventing MM, it is within this framework that my innovative idea is to train TBAs to use oral misoprostol immediately after childbirth to prevent maternal bleeding and to refer promptly to hospital if the bleeding continues. The idea also includes making Misoprostol available through programming by advocacy to relevant stakeholders to increase its availability, accessibility and service delivery. This idea is unique because currently there is no programme in place to train and scale up the use of this drug among TBAs. Misoprostol is a potent stimulator of uterine contractions in the few hours after childbirth to prevent maternal bleeding. It can be administered through several routes –oral, sublingual, rectal, buccal and vagina. Its low cost, ease of use and excellent safety profile as well as its long shelf life in tropical climates make it the only uterotonic drug appropriate for home deliveries without a skilled birth attendant. One tablet (200mcg) of Misoprostol costs 25 Cents. Its absorption is fast in all routes, but the most rapid action occurs when it is given orally. Misoprostol is now widely available in Nigeria. In January 2010, the Nigerian Federal Ministry of Health (FMOH) included Misoprostol into the National essential drug list enabling this drug to be included in private sector procurement list at all levels of government.
WHARC recently completed an intervention of Local Government Areas in Edo and Ondo states of Nigeria to prevent and treat PPH in rural areas of these states through capacity building of primary health care workers to properly dispense Misoprostol for treatment and prevention of PPH and to ensure its availability in line with guidelines provided by Nigeria’s FMOH and WHO. The impact of this intervention will be felt in these LGAs, other LGAs in Nigeria and beyond as capacity building of informal maternity care providers at delivery will serve to prevent maternal mortality from PPH until skilled birth attendants are widely available. Many of the research outcomes would evolve to become instruments of new policy change in many situations from which mothers would benefit tremendously in low resource settings like ours.
There is need to train informal maternity care providers on the use of Misoprostol especially in rural areas and scale up service delivery to prevent and treat maternal bleeding after childbirth in order to prevent maternal death from primary postpartum haemorrhage.