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 three Local Government Areas (LGAs) in Edo State, South-South
Nigeria through capacity building of Primary Health Care (PHC) workers and the routine
administration of oral misoprostol at the time of delivery.
Forty Six PHCs in Esan West, Esan Central and Igueben LGAs 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 labor and the lack of drugs for the routine prevention and
treatment of PPH were documented in all the PHCs visited.
The project interventions consisted of capacity workshops of health providers on PPH
management, service delivery on PPH prevention and treatment with misoprostol, advocacy
and public health education, pharmacists ́ training and the establishment of a drug revolving
fund (DRF) in the private sector, and project monitoring and evaluation.
Overall, a total of 336 health personnel were trained in the three LGAs consisting of 42
doctors, 129 nurses/midwives, 68 community health extension workers, five pharmacists, 45
patent medicines dealers and 47 peer advocates. Over a period of five months (May-October
2009), a total of 2049 deliveries took place in the 46 PHCs. Of these, 970 received 600
micrograms oral misoprostol for the routine prevention of PPH. Only four 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 in the
group of women.
Five pharmacists were trained on PPH and use of misoprostol and they included Richbec
Pharmacy, Faithdome Pharmacy, WillyChucks Pharmacy, Rehoboth Pharmacy, and Royal
Pharmacy. Each pharmacy received 600 packets of misoprostol with which they commenced
the DRF. To date, all these first batch of drugs have been purchased by clients and health
providers in the LGAs, while the DRF is progressing well.
Public health education and advocacy activities were carried out consisting of TV talk shows,
community sensitization seminars and advocacy visits to political office holders. This
component of the project was highly successful in raising community awareness of the
project and in increasing the commitment of local government officials to provide resources
for reducing maternal mortality in the LGAs with misoprostol.