title: Is attendant at delivery associated with the use of interventions to prevent postpartum hemorrhage at home births? The case of Bangladesh.
abstract: BACKGROUND
  Hemorrhage is the leading cause of maternal mortality in Bangladesh, the majority of which is due to postpartum hemorrhage (PPH), blood loss of 500 mL or more. Many deaths due to PPH occur at home where approximately 77% of births take place. This paper aims to determine whether the attendant at home delivery (i.e. traditional birth attendant (TBA) trained on PPH interventions, TBA not trained on interventions, or lay attendant) is associated with the use of interventions to prevent PPH at home births.
  
  
  METHODS
  Data come from operations research to determine the safety, feasibility, and acceptability of scaling-up community-based provision of misoprostol and an absorbent delivery mat in rural Bangladesh. Analyses were done using data from antenatal care (ANC) cards of women who delivered at home without a skilled attendant (N =66,489). Multivariate logistic regression was used to assess the likelihood of using the interventions.
  
  
  RESULTS
  Overall, 67% of women who delivered at home without a skilled provider used misoprostol and the delivery mat (the interventions). Women who delivered at home and had a trained TBA present had 2.72 (95% confidence interval, 2.15-3.43) times the odds of using the interventions compared to those who had a lay person present. With each additional ANC visit (maximum of 4) a woman attended, the odds of using the interventions increased 2.76 times (95% confidence interval, 2.71-2.81). Other sociodemographic variables positively associated with use of the interventions were age, secondary or higher education, and having had a previous birth.
  
  
  CONCLUSIONS
  Findings indicate that trained TBAs can have a significant impact on utilization of interventions to prevent PPH in home births. ANC visits can be an important point of contact for knowledge transfer and message reinforcement about PPH prevention.
authors.affiliation: Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, 229 University Hall, UC-Berkeley, Berkeley, CA 94720-7360, USA. ndola@berkeley.edu.
authors.forename: Ndola
authors.initials: N
authors.lastname: Prata
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bell
authors.forename: Martine
authors.initials: M
authors.lastname: Holston
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Quaiyum
mesh_terms: D041342:Absorbent Pads; D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D004522:Educational Status; D005260:Female; D006700:Home Childbirth / Q000451:nursing; D006701:Home Nursing; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D008880:Midwifery / Q000193:education*; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use*; D010298:Parity; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000517:prevention & control*; D011295:Prenatal Care; D012646:Self Administration; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol