title: Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: operations research study in Nepal.
abstract: OBJECTIVE
  To determine feasibility of community-based distribution of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant woman 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- and postintervention surveys (28 clusters, each with 30 households). Maternal deaths were ascertained through systematic health facility and community-based surveillance; causes of death were assigned based on verbal autopsy.
  
  
  RESULTS
  Of 840 postintervention survey respondents, 73.2% received misoprostol. The standardized proportion of vaginal deliveries protected by a uterotonic rose from 11.6% to 74.2%. Those experiencing the largest gains were the poor, the illiterate, and those living in remote areas.
  
  
  CONCLUSIONS
  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 particularly large gains among the disadvantaged.
authors.affiliation: Options/Cambodia.
authors.forename: Swaraj
authors.initials: S
authors.lastname: Rajbhandari
authors.forename: Stephen
authors.initials: S
authors.lastname: Hodgins
authors.forename: Harshad
authors.initials: H
authors.lastname: Sanghvi
authors.forename: Robert
authors.initials: R
authors.lastname: McPherson
authors.forename: Yasho V
authors.initials: YV
authors.lastname: Pradhan
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D000328:Adult; D003150:Community Health Workers; D003695:Delivery of Health Care; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006700:Home Childbirth; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use*; D009390:Nepal; D009874:Operations Research; D010120:Oxytocics / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D012646:Self Administration
chemical_list: D010120:Oxytocics; D016595:Misoprostol