title: Feasibility and acceptability of clean birth kits containing misoprostol for self-administration to prevent postpartum hemorrhage in rural Papua New Guinea.
abstract: OBJECTIVE
  To determine the feasibility and acceptability of providing clean birth kits (CBKs) containing misoprostol for self-administration in a rural setting in Papua New Guinea.
  
  
  METHODS
  A prospective intervention study was conducted between April 8, 2013, and October 24, 2014. Eligible participants were women in the third trimester of pregnancy who attended a prenatal clinic in Unggai Bena. Participants received individual instruction and were then given a CBK containing 600μg misoprostol tablets for self-administration following an unsupervised birth if they could demonstrate their understanding of correct use of items in the CBK. Data regarding the use and acceptability of the CBK and misoprostol were collected during postpartum follow-up.
  
  
  RESULTS
  Among 200 participants, 106 (53.0%) had an unsupervised birth, and 99 (93.4%) of these women used the CBK. All would use the CBK again and would recommend it to others. Among these 99 women, misoprostol was self-administered by 98 (99.0%), all of whom would take the drug again and would recommend it to others.
  
  
  CONCLUSIONS
  The findings strengthen the case for community-based use of misoprostol to prevent postpartum hemorrhage in remote communities. Large-scale interventions should be planned to further evaluate impact and acceptability.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. Electronic address: lvallely@kirby.unsw.edu.au.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Vallely
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors.forename: Primrose
authors.initials: P
authors.lastname: Homiehombo
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Walep
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors.forename: Michael
authors.initials: M
authors.lastname: Moses
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors.forename: Marynne
authors.initials: M
authors.lastname: Tom
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Kelly-Hanku
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vallely
authors.affiliation: Eastern Highlands Provincial Health Authority, Goroka, Papua New Guinea.
authors.forename: Eluo
authors.initials: E
authors.lastname: Nataraye
authors.affiliation: Susu Mamas PNG, Mount Hagen, Papua New Guinea.
authors.forename: Caroline
authors.initials: C
authors.lastname: Ninnes
authors.affiliation: School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
authors.forename: Glen D
authors.initials: GD
authors.lastname: Mola
authors.affiliation: Centre of International Health, Burnet Institute, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Morgan
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.affiliation: School of Social Sciences, Faculty of Arts, Monash University, Melbourne, VIC, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Whittaker
authors.affiliation: Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney, NSW, Australia.
authors.forename: Caroline S E
authors.initials: CS
authors.lastname: Homer
mesh_terms: D000328:Adult; D005260:Female; D006700:Home Childbirth / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use*; D010219:Papua New Guinea; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011446:Prospective Studies; D012424:Rural Population; D012646:Self Administration / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol
keywords: Clean birth kit; Papua New Guinea; Postpartum hemorrhage; Rural and remote settings; Self-administered misoprostol; Unsupervised birth