title: Programmes for advance distribution of misoprostol to prevent post-partum haemorrhage: a rapid literature review of factors affecting implementation.
abstract: Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synthesizes current knowledge about the barriers and facilitators affecting implementation of advance community distribution of misoprostol to prevent PPH, where misoprostol may be self-administered or administered by an LHW.We searched for and summarized available empirical evidence, and collected primary data from programme stakeholders about their experiences of programme implementation.We present key outcomes and features of advanced distribution programmes that are in operation or have been piloted globally. We categorized factors influencing implementation into those that operate at the health system level, factors related to the community and policy context and those factors more closely connected to the end user.Debates around advance distribution have centred on the potential risks and benefits of making misoprostol available to pregnant women and community members during pregnancy for administration in the home. However, the risks of advance distribution appear manageable and the benefits of self-administration, especially for women who have little chance of expert care for PPH, are considerable.
authors: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK, Helen.smith-4@manchester.ac.uk.
authors: Helen J
authors: HJ
authors: Smith
authors: Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa.
authors: Christopher J
authors: CJ
authors: Colvin
authors: Department for International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
authors: Esther
authors: E
authors: Richards
authors: Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa.
authors: Jeffrey
authors: J
authors: Roberson
authors: United Mission to Nepal, Kathmandu, Nepal.
authors: Geeta
authors: G
authors: Sharma
authors: Jhpiego (an affiliate of Johns Hopkins University), Lalitpur, Nepal and.
authors: Kusum
authors: K
authors: Thapa
authors: UNDP/UNFPA/UNICEF/WHO/World Bank Special programme of research, development and research training in human reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors: A Metin
authors: AM
authors: Gülmezoglu
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000600:supply & distribution*; D005260:Female; D006700:Home Childbirth; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000600:supply & distribution*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Advance distribution; community distribution; direct distribution; misoprostol; post-partum haemorrhage; prevention; programme implementation