- : Ms Word, Ms Word Format
- : 70 Pages
- : ₦5,000
- : 1-5 Chapters
- Click to DOWNLOAD Materials
A COMPARATIVE STUDY OF TWO APPROACHES OF DISTRIBUTING MISOPROSTOL FOR THE PREVENTION OF POSTPARTUM HEMORRHAGE IN SABON-GARI LOCAL
Abstract
Introduction – Nigeria has one of the highest maternal mortality ratios in the world. The National Demographic and Health Survey (NDHS 2008) recorded 545/100,000 live births. Postpartum hemorrhage is the leading cause of maternal mortality with figures as high as 44% reported in Nigeria. Current interventions available for prevention and treatment require Active Management of Third Stage of Labour (AMTSL), use of injectable oxytocin by a skilled attendant in a health facility and a cold chain which is not feasible and accessible for the majority of births which take place at home in low resource settings. A study in Zaria has demonstrated the feasibility of community based distribution of misoprostol for prevention of PPH with overwhelming success. This study aims to compare two distribution strategies for misoprostol at community level on its uptake for the prevention of postpartum hemorrhage in two semi-urban communities in Sabon-Gari L.G.A. of Kaduna State.
Methodology – The community-based comparative intervention study was carried out between July 2011 and June 2012. A multistage sampling method was used to select 300 pregnant women and women who had delivered six months prior to the survey at baseline and 320 pregnant women and women who had delivered within six months of the intervention for the endline survey. A monitoring phase was carried out for six (6) months in between the baseline and endline where all 284 deliveries in both study communities were monitored whether they used or did not use misoprostol during home births. A pre-tested semi-structured interviewer administered questionnaire with open and closed ended questions was used to obtain baseline data. Following the same community dialogues, trainings, Information Education and Communication (IEC) campaign and depositing misoprostol in Hayin Dogo and Basawa communities, the same data collection tool was used to monitor deliveries and also collect the endline data. Also, a Primary Health Care/facility-based distribution strategy for misoprostol for Hayin Dogo, and a village head-based distribution strategy (whereby drugs were kept and collected from the house of the village head) for Basawa was established. The data was cleaned and analysed using Statistical Package for Social Sciences (SPSS version 17) and presented as tables. The knowledge was scored and graded as Poor,<49%; Fair, 50-69% and Good, >70%. A p-value of <0.05 was considered significant.
Result – The baseline knowledge of PPH and its signs and symptoms were similar in both communities (about 60%) and that of misoprostol, its dosage and side effect were poor in both study communities. The knowledge of causes, prevention and treatment of PPH was poor in the two study communities (98% poor knowledge in Hayin Dogo and 97.3% in Basawa). At post intervention, there was a general improvement in knowledge of causes,
15
prevention and treatment of PPH in both communities, especially in their knowledge of misoprostol. A comparable proportion of women knew PPH can cause death (more than 75% in both communities). About 6 out of 10 women in both communities said a woman with PPH should go to the health facility promptly. The knowledge of use and dosage of misoprostol was at least 70% in each of the two communities. The knowledge of side effects was low except for knowledge of shivering which accounted for 73% and 93% in Hayin dogo and Basawa respectively. The differences in post intervention scores between the two communities was statistically significant at p<0.05. In spite of the intervention, the overall post intervention knowledge recorded increased in both communities. Only about 7% of the population in both Hayin dogo and Basawa had fair knowledge of causes, prevention and treatment of PPH using misoprostol. The difference in knowledge between the two communities was not statistically significant at post intervention (χ2=0.005; df=1; p>0.05).
The uptake of misoprostol at baseline was similar in both communities. At post intervention, the uptake of misoprostol was about half (48.5%) in Hayin Dogo and over a third (37.7%) in Basawa. Hayin Dogo recorded slight increase in uptake of 48.5% compared to Basawa which recorded 37.7% uptake of misoprostol. The difference in uptake between the Health Facility and Community-based distribution was not statistically significant at (z=-1.9;df=318;p>0.05).
Conclusion – There was an increase in the knowledge of causes, prevention and treatment of PPH, including the use of misoprostol during homebirths in Hayin Dogo and Basawa communities using the Health facility and community based distribution strategies respectively. The Health facility distribution strategy recorded a higher uptake of misoprostol for the prevention and treatment of PPH compared to the community-based distribution strategy which was not statistically significant.
Both strategies of increasing awareness and including misoprostol into antenatal care services and community based distribution are feasible strategies towards increasing the use of misoprostol during homebirths for the prevention of postpartum haemorrhage.
In order to enhance the desired effect of the respective distribution strategies, the local government should include the misoprostol Health Facility distribution strategy and integrate it into all antenatal care and delivery services and sustain the continuous supply of misoprostol to pregnant women at ANC service points and also increase awareness for all PHC workers involved in antenatal care and delivery services in order to sustain the demand and use of misoprostol after delivery by pregnant women who attend ANC. Pregnant women and TBAs at community level should be encouraged by health care workers with the right key messages to collect misoprostol earlier than the 36 weeks gestational age to keep in preparation for delivery as this may help increase coverage substantially and encourage women who may not return to health facilities to deliver but deliver at home under the supervision of the TBA.
Title Page———i
Certification——–ii
Dedication———iii
Acknowledgement——-iv
Abstract ———vi
Table of Content——–vii
Chapter One
1.0 Introduction ——-1
1.1 Statement of Problem——4
1.2 Purpose of the Study——5
1.3 Significance of Study——8
1.4 Limitation——–9
1.5 Scope of Study——-11
Chapter Two
2.0 Review of Related Literature —-12
2.6 Summary of Literature Review—- 19
Chapter Three
3.0 Research Methodology and Procedure—22
3.1 Population ——–22
3.2 Sample and Sampling Technique—-22
3.3 Validation of the Instrument —-23
3.4 Reliability of the Instrument —–23
3.5 Data Analysis——-23
Chapter Four
4.0 Presentation and Discussion of Result—24
4.1 Analysis and interpretaion of Data—25
4.2 Discussion of Results——38
Chapter Five
5.0. Summary, Conclusion, and Recommendation –40
5.1 Summary——–40
5.2 Conclusion——–41
5.3 Recommendation——42
References ———45
Appendix 1——–47
Appendix ———50
