title: Prevention of postpartum hemorrhage at home birth in Afghanistan.
abstract: OBJECTIVE
  To test the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan.
  
  
  METHODS
  A nonrandomized experimental control design in rural Afghanistan.
  
  
  RESULTS
  A total of 3187 women participated: 2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were unexpectedly lower in the intervention group than in the comparison group. Among women in the intervention group, 92% said they would use misoprostol in their next pregnancy. In the intervention area where community-based distribution of misoprostol was introduced, near-universal uterotonic coverage (92%) was achieved compared with 25% coverage in the control areas.
  
  
  CONCLUSIONS
  In Afghanistan, community-based education and distribution of misoprostol is safe, acceptable, feasible, and effective. This strategy should be considered for other countries where access to skilled attendance is limited.
authors.affiliation: Jhpiego, Baltimore, Maryland, USA. hsanghvi@jhpiego.org
authors.forename: Harshadkumar
authors.initials: H
authors.lastname: Sanghvi
authors.forename: Nasratullah
authors.initials: N
authors.lastname: Ansari
authors.forename: Ndola J V
authors.initials: NJ
authors.lastname: Prata
authors.forename: Hannah
authors.initials: H
authors.lastname: Gibson
authors.forename: Aftab T
authors.initials: AT
authors.lastname: Ehsan
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Smith
mesh_terms: D000346:Afghanistan; D003150:Community Health Workers; D005240:Feasibility Studies; D005260:Female; D006266:Health Education; D006700:Home Childbirth; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D015397:Program Evaluation; D012646:Self Administration
chemical_list: D010120:Oxytocics; D016595:Misoprostol