The project was designed to determine the feasibility and relative program effectiveness of an approach aimed at improving the prevention and treatment of primary postpartum hemorrhage (PPH) in four Local Government Areas (LGAs) in Ondo State, Nigeria through capacity building of Primary Health Care (PHC) workers and the routine administration of oral misoprostol at the time of delivery.
Eighty PHCs in Owo, Akure South, Ifedore and Akoko North West Local Government Areas (LGA) in the State were involved in the project. The project started with a needs assessment during which poor procedures for managing the third stage of labour and the lack of drugs for the routine prevention and treatment of PPH were documented in all the PHCs visited. The needs assessment also revealed a high proportion of pregnant women using faith-based providers for antenatal care (ANC) and delivery despite a policy of free maternity services in the state
The project interventions consisted of capacity building workshops for health care providers on PPH management, service delivery on PPH prevention and treatment with misoprostol, advocacy and public health education, pharmacists´ training, the establishment of a drug revolving fund (DRF) for misoprostol in the private sector, and project monitoring and evaluation.
Overall, a total of 542 health personnel were trained in the four LGAs including 58 doctors, 178 nurses/midwives, 166 community health extension workers, 18 pharmacists, 60 patent medicine dealers (PMD) and 62 peer advocates. Over a period of five months (May-October 2009), a total of 1726 deliveries took place in the 83 primary health care (PHC) centres. Of these, 784 received 600 micrograms oral misoprostol for the routine prevention of PPH. Only six cases of PPH were recorded in the cohort of women, and these were all in women who had not received routine prevention doses of misoprostol. The women with PPH were all successfully treated with misoprostol, and no case of PPH referral to secondary or tertiary hospital was recorded among these women.
Eighteen pharmacists were trained on PPH and the use of misoprostol. These included Kanada Pharmacy, Matador Pharmacy, His Grace Pharmacy, De Chris Pharmacy, GodMan Pharmacy and Zubik Pharmacy. Each received 600 packets of misoprostol with which they commenced the DRF. To date, all of the tablets in the first batch have been purchased by clients and health care providers in the LGAs, while the DRF is progressing well.
Public health education and advocacy activities were carried out consisting of advocacy visits to the State Governor, Commissioner for Health and Chairmen of the four LGAs, and community sensitization seminars. This component of the project was highly successful in raising community awareness of the project and in increasing the commitment of government officials to provide resources for reducing maternal mortality in the LGAs with misoprostol.