title: Advance distribution of misoprostol for the prevention of postpartum hemorrhage in South Sudan.
abstract: OBJECTIVE
  To determine if high uterotonic coverage can be achieved in South Sudan through a facility- and community-focused postpartum hemorrhage (PPH) prevention program.
  
  
  METHODS
  The program was implemented from October 2012 to March 2013. At health facilities, active management of the third stage of labor (AMTSL) was emphasized. During prenatal care and home visits, misoprostol was distributed to pregnant women at approximately 32 weeks of pregnancy for the prevention of PPH at home births. Data on uterotonic coverage and other program outcomes were collected through facility registers, home visits, and postpartum interviews.
  
  
  RESULTS
  In total, 533 home births and 394 facility-based births were reported. Misoprostol was distributed in advance to 787 (84.9%) pregnant women, of whom 652 (82.8%) received the drug during home visits. Among the women who delivered at home, 527 (98.9%) reported taking misoprostol. A uterotonic for PPH prevention was provided at 342 (86.8%) facility-based deliveries. Total uterotonic coverage was 93.7%. No adverse events were reported.
  
  
  CONCLUSIONS
  It is feasible to achieve high coverage of uterotonic use in a low-resource and postconflict setting with few skilled birth attendants through a combination of advance misoprostol distribution and AMTSL at facilities. Advance distribution through home visits was key to achieving high coverage of misoprostol use.
authors: Maternal and Child Health Integrated Program, Jhpiego, Washington DC, USA. Electronic address: jeffrey.smith@jhpiego.org.
authors: Jeffrey M
authors: JM
authors: Smith
authors: Ministry of Health, Government of South Sudan, Juba, South Sudan.
authors: Alexander
authors: A
authors: Dimiti
authors: Maternal and Child Health Integrated Program, JSI Research and Training Institute, Washington DC, USA.
authors: Vikas
authors: V
authors: Dwivedi
authors: Integrated Service Delivery Project, Jhpiego, Juba, South Sudan.
authors: Isabella
authors: I
authors: Ochieng
authors: Mundri Relief and Development Association, Juba, South Sudan.
authors: Maryrose
authors: M
authors: Dalaka
authors: Maternal and Child Health Integrated Program, Jhpiego, Washington DC, USA.
authors: Sheena
authors: S
authors: Currie
authors: Integrated Service Delivery Project, Jhpiego, Juba, South Sudan.
authors: Edward Eremugo
authors: EE
authors: Luka
authors: International Finance Corporation, Juba, South Sudan.
authors: John
authors: J
authors: Rumunu
authors: Integrated Service Delivery Project, Jhpiego, Juba, South Sudan.
authors: Solomon
authors: S
authors: Orero
authors: Jhpiego, Baltimore, MD, USA.
authors: Jaime
authors: J
authors: Mungia
authors: Integrated Service Delivery Project, Jhpiego, Juba, South Sudan.
authors: Catharine
authors: C
authors: McKaig
mesh_terms: D005260:Female; D006700:Home Childbirth; D006801:Humans; D007743:Labor, Obstetric; D008427:Maternal Health Services; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D013397:Sudan
chemical_list: D010120:Oxytocics; D016595:Misoprostol
keywords: Active management of the third stage of labor; Advance distribution; Community health workers; Coverage; Home birth; Misoprostol; Postpartum hemorrhage prevention; Safety