title: Uterotonic use immediately following birth: using a novel methodology to estimate population coverage in four countries.
abstract: BACKGROUND
  Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in developing countries. While incidence of PPH can be dramatically reduced by uterotonic use immediately following birth (UUIFB) in both community and facility settings, national coverage estimates are rare. Most national health systems have no indicator to track this, and community-based measurements are even more scarce. To fill this information gap, a methodology for estimating national coverage for UUIFB was developed and piloted in four settings.
  
  
  METHODS
  The rapid estimation methodology consisted of convening a group of national technical experts and using the Delphi method to come to consensus on key data elements that were applied to a simple algorithm, generating a non-precise national estimate of coverage of UUIFB. Data elements needed for the calculation were the distribution of births by location and estimates of UUIFB in each of those settings, adjusted to take account of stockout rates and potency of uterotonics. This exercise was conducted in 2013 in Mozambique, Tanzania, the state of Jharkhand in India, and Yemen.
  
  
  RESULTS
  Available data showed that deliveries in public health facilities account for approximately half of births in Mozambique and Tanzania, 16% in Jharkhand and 24% of births in Yemen. Significant proportions of births occur in private facilities in Jharkhand and faith-based facilities in Tanzania. Estimated uterotonic use for facility births ranged from 70 to 100%. Uterotonics are not used routinely for PPH prevention at home births in any of the settings. National UUIFB coverage estimates of all births were 43% in Mozambique, 40% in Tanzania, 44% in Jharkhand, and 14% in Yemen.
  
  
  CONCLUSIONS
  This methodology for estimating coverage of UUIFB was found to be feasible and acceptable. While the exercise produces imprecise estimates whose validity cannot be assessed objectively in the absence of a gold standard estimate, stakeholders felt they were accurate enough to be actionable. The exercise highlighted information and practice gaps and promoted discussion on ways to improve UUIFB measurement and coverage, particularly of home births. Further follow up is needed to verify actions taken. The methodology produces useful data to help accelerate efforts to reduce maternal mortality.
authors.affiliation: Maternal and Child Survival Program, Jhpiego, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA. Jim.ricca@jhpiego.org.
authors.forename: Jim
authors.initials: J
authors.lastname: Ricca
authors.affiliation: Maternal and Child Survival Program, JSI Research & Training Institute, Inc, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA. vdwivedi@jsi.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Dwivedi
authors.affiliation: Maternal and Child Survival Program, Jhpiego, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA. John.varallo@jhpiego.org.
authors.forename: John
authors.initials: J
authors.lastname: Varallo
authors.affiliation: Jhpiego, 221, Okhla Phase III, New Delhi, 110 020, India. Gajendra.Singh@jhpiego.org.
authors.forename: Gajendra
authors.initials: G
authors.lastname: Singh
authors.affiliation: Maternal Child Integrated Program (MCHIP), Jhpiego, Government Vaccine Institute Campus, Namkum, Ranchi, Jharkhand, 834010, India. Suranjeen.Pallipamula@jhpiego.org.
authors.forename: Suranjeen Prasad
authors.initials: SP
authors.lastname: Pallipamula
authors.affiliation: Director of Maternal and Child Health, Ministry of Health, Maputo, Mozambique. naibrahimo@yahoo.com.br.
authors.forename: Nazir
authors.initials: N
authors.lastname: Amade
authors.affiliation: MCHIP, Jhpiego, Maputo, Mozambique. Maria.vaz@jhpiego.org.
authors.forename: Maria
authors.initials: M
authors.lastname: de Luz Vaz
authors.affiliation: MCHIP, Jhpiego, PO Box 9170, Dar es Salaam, Tanzania. dustan.bishanga@jhpiego.org.
authors.forename: Dustan
authors.initials: D
authors.lastname: Bishanga
authors.affiliation: Jhpiego Tanzania, PO Box 9170, Dar es Salaam, Tanzania. Marya.plotkin@jhpiego.org.
authors.forename: Marya
authors.initials: M
authors.lastname: Plotkin
authors.affiliation: MCHIP, Yemen, Haddah Street, Sana'a City, Yemen. Bushra.Al-Makaleh@jhpiego.org.
authors.forename: Bushra
authors.initials: B
authors.lastname: Al-Makaleh
authors.affiliation: Maternal and Child Survival Program, Jhpiego, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA. Stephanie.suhowatsky@jhpiego.org.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Suhowatsky
authors.affiliation: Maternal and Child Survival Program, Jhpiego, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA. Jeffrey.Smith@Jhpiego.org.
authors.forename: Jeffrey Michael
authors.initials: JM
authors.lastname: Smith
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data*; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D003697:Delphi Technique; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D008297:Male; D008428:Maternal Mortality; D008875:Middle Aged; D008880:Midwifery / Q000706:statistics & numerical data*; D009073:Mozambique / Q000453:epidemiology; D010120:Oxytocics / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D015203:Reproducibility of Results; D013636:Tanzania / Q000453:epidemiology; D015006:Yemen / Q000453:epidemiology
chemical_list: D010120:Oxytocics