A regional comparison of distribution strategies and women’s awareness, receipt, and use of misoprostol to prevent postpartum hemorrhage in rural Amhara and Oromiya regions of Ethiopia

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Study Justification:
– Postpartum hemorrhage is a leading cause of maternal death in Ethiopia.
– The Maternal Health in Ethiopia Partnership (MaNHEP) project implemented a community-based model of maternal and newborn health, including the use of misoprostol to prevent postpartum hemorrhage.
– This study aims to assess the regional trends in women’s use of misoprostol and factors associated with its use.
Study Highlights:
– Misoprostol use increased rapidly and remained stable over 20 months.
– There were significant regional differences, with more women in Oromiya being aware of misoprostol, receiving it, and using it compared to women in Amhara.
– Most women who received misoprostol used it, regardless of age, parity, or education.
– Factors associated with misoprostol use included Oromiya residence, attending Community Maternal and Newborn Health (CMNH) family meetings, receiving antenatal care, and being attended at birth by a skilled provider or trained health worker.
Study Recommendations:
– Increase awareness and access to misoprostol in the Amhara region to match the levels in Oromiya.
– Strengthen the implementation of CMNH family meetings to promote misoprostol use.
– Encourage pregnant women to receive antenatal care and be attended at birth by skilled providers or trained health workers.
– Continue early distribution of misoprostol to pregnant women, as it appears to be safe and unrelated to the choice of birthplace.
Key Role Players:
– Maternal Health in Ethiopia Partnership (MaNHEP) project team
– Community Maternal and Newborn Health (CMNH) facilitators
– Skilled providers and trained health workers
– Traditional birth attendants
– Community health development agents
Cost Items for Planning Recommendations:
– Training and capacity building for CMNH facilitators and health workers
– Awareness campaigns and materials
– Distribution of misoprostol
– Monitoring and evaluation activities
– Support for antenatal care services
– Incentives or compensation for skilled providers and trained health workers
– Coordination and collaboration efforts between stakeholders

Introduction: In Ethiopia, postpartum hemorrhage is a leading cause of maternal death. The Maternal Health in Ethiopia Partnership (MaNHEP) project developed a community-based model of maternal and newborn health focusing on birth and early postpartum care. Implemented in the Amhara and Oromiya regions, the model included misoprostol to prevent postpartum hemorrhage. This article describes regional trends in women’s use of misoprostol; their awareness, receipt, and use of misoprostol at project’s endline; and factors associated with its use. Methods: The authors assessed trends in use of misoprostol using monthly data from MaNHEP’s quality improvement database; and awareness, receipt, use, and correct use of misoprostol using data from MaNHEP’s endline survey of 1019 randomly sampled women who gave birth during the year prior to the survey. Results: Misoprostol use increased rapidly and was relatively stable over 20 months, but regional differences were stark. At endline, significantly more women in Oromiya were aware of misoprostol compared with women who resided in Amhara (94% vs 59%); significantly more had received misoprostol (80% vs 35%); significantly more had received it during pregnancy (93% vs 48%); and significantly more had received it through varied sources. Most women who received misoprostol used it (> 95%) irrespective of age, parity, or education. Factors associated with use were Oromiya residence (odds ratio [OR] 9.48; 95% confidence interval [CI], 6.78-13.24), attending 2 or more Community Maternal and Newborn Health (CMNH) family meetings (OR 2.62; 95% CI, 1.89-3.63), receiving antenatal care (OR 1.67; 95% CI, 1.08-2.58) and being attended at birth by a skilled provider or trained health extension worker, community health development agent, or traditional birth attendant versus an untrained caregiver or no one. Correct use was associated with having attended 2 or more CMNH family meetings (OR 2.02; 95% CI, 1.35-3.03). Discussion: Multiple distribution channels increase women’s access to misoprostol. Most women who have access to misoprostol use it. Early distribution to pregnant women who are educated to use misoprostol appears to be safe and unrelated to choice of birthplace. © 2014 by the American College of Nurse-Midwives.

Innovation 1: Mobile Distribution Units
To strengthen distribution channels, an innovation could involve the use of mobile distribution units. These units would travel to rural areas, collaborating with local health facilities, community health workers, and traditional birth attendants to provide misoprostol directly to pregnant women. This would ensure that the medication is readily available and easily accessible to those who need it.

Innovation 2: Interactive Mobile Messaging
To increase awareness about misoprostol, an innovation could involve the use of interactive mobile messaging. Pregnant women could receive regular text messages or voice messages providing information about the benefits and availability of misoprostol. This would help to educate and remind women about the importance of using the medication to prevent postpartum hemorrhage.

Innovation 3: Misoprostol Kits during Antenatal Care Visits
To ensure early distribution of misoprostol, an innovation could involve providing misoprostol kits to pregnant women during their antenatal care visits. These kits would include the medication along with educational materials on its proper use and potential benefits. This would ensure that women receive the medication early in their pregnancy and are educated on how to use it correctly.

Innovation 4: Virtual Community Maternal and Newborn Health (CMNH) Meetings
To engage communities and provide information on maternal health, an innovation could involve virtual CMNH meetings. Pregnant women and their families could participate in online meetings where they receive information on maternal health, including the use of misoprostol. This would allow for regular communication and education, even in areas where physical meetings may be challenging to organize.
AI Innovations Description
Based on the research article titled “A regional comparison of distribution strategies and women’s awareness, receipt, and use of misoprostol to prevent postpartum hemorrhage in rural Amhara and Oromiya regions of Ethiopia,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening Distribution Channels: The research findings suggest that multiple distribution channels increase women’s access to misoprostol, a medication used to prevent postpartum hemorrhage. To improve access to maternal health, it is recommended to strengthen and expand the distribution channels for misoprostol in rural areas. This can be achieved by collaborating with local health facilities, community health workers, and traditional birth attendants to ensure that misoprostol is readily available to pregnant women.

2. Increasing Awareness: The study found that women in the Oromiya region had significantly higher awareness of misoprostol compared to women in the Amhara region. To improve access to maternal health, it is important to increase awareness about the benefits and availability of misoprostol among pregnant women in all regions. This can be done through community education programs, antenatal care visits, and the use of mass media campaigns.

3. Early Distribution to Pregnant Women: The research suggests that early distribution of misoprostol to pregnant women, along with education on its correct use, is safe and unrelated to the choice of birthplace. To improve access to maternal health, it is recommended to provide misoprostol to pregnant women during antenatal care visits, ensuring that they are educated on its proper use and potential benefits.

4. Community Engagement: The study found that attending Community Maternal and Newborn Health (CMNH) family meetings was associated with increased use and correct use of misoprostol. To improve access to maternal health, it is recommended to engage communities through regular CMNH family meetings, where pregnant women and their families can receive information on maternal health, including the use of misoprostol.

By implementing these recommendations, it is possible to develop an innovation that improves access to maternal health, specifically in the context of preventing postpartum hemorrhage in rural areas of Ethiopia.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Strengthening Distribution Channels: The impact of strengthening and expanding distribution channels can be assessed by conducting a pilot program in selected rural areas. The program can involve collaborating with local health facilities, community health workers, and traditional birth attendants to ensure the availability of misoprostol to pregnant women. Data can be collected on the number of women who have access to misoprostol through these channels and their utilization rates.

2. Increasing Awareness: To measure the impact of increasing awareness, a pre- and post-intervention survey can be conducted in both the Amhara and Oromiya regions. The survey can assess women’s awareness of misoprostol before and after implementing community education programs, antenatal care visits, and mass media campaigns. The increase in awareness can be measured by comparing the survey results before and after the intervention.

3. Early Distribution to Pregnant Women: The impact of early distribution of misoprostol to pregnant women can be evaluated by implementing a program that provides misoprostol during antenatal care visits. Data can be collected on the number of pregnant women who receive misoprostol during antenatal care visits and their subsequent utilization rates. The program can also include education on the correct use of misoprostol, and data can be collected on the women’s knowledge and adherence to the correct usage guidelines.

4. Community Engagement: To assess the impact of community engagement through CMNH family meetings, data can be collected on the attendance of pregnant women and their families at these meetings. The program can track the number of women who attend the meetings and their subsequent use and correct use of misoprostol. The impact can be measured by comparing the utilization rates of misoprostol among women who attended the meetings versus those who did not.

By collecting data on the implementation of these recommendations and comparing it to baseline data, the impact of these interventions on improving access to maternal health can be evaluated. This evaluation can help identify the effectiveness of each recommendation and guide further improvements in the intervention strategies.

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