Community mobilization to reduce postpartum hemorrhage in home births in northern Nigeria

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Study Justification:
– The study aims to demonstrate the importance of community mobilization in the uptake of a health intervention, specifically the distribution of misoprostol to prevent postpartum hemorrhage.
– The current near-epidemic maternal mortality conditions in northern Nigeria highlight the urgent need for effective interventions.
– Theories of community participation support the approach of involving community members in the distribution and use of misoprostol.
Study Highlights:
– The study was conducted in five communities around Zaria, Nigeria.
– Community leaders and selected community members participated in dialogs, and community education sessions were held.
– A total of 1875 women were enrolled in the study, with the majority delivering at home and having low skilled attendance at delivery.
– Community mobilization efforts reached most women with information about postpartum hemorrhage and misoprostol, resulting in high comprehension of intervention messages.
– Traditional birth attendants (TBAs) and community-oriented resource persons (CORPs) were identified as important sources of information about misoprostol.
Study Recommendations:
– The study suggests that even modest levels of community participation can have a significant impact on the successful distribution and uptake of health interventions.
– Policy change should be promoted to support the integration of community mobilization strategies in health care interventions.
Key Role Players Needed to Address Recommendations:
– Community leaders: They play a crucial role in mobilizing the community and promoting the uptake of health interventions.
– Traditional birth attendants (TBAs): They are important sources of information and can help in the distribution and use of misoprostol.
– Community-oriented resource persons (CORPs): They can provide education and support to community members regarding postpartum hemorrhage and misoprostol.
Cost Items to Include in Planning Recommendations:
– Training and capacity building for community leaders, TBAs, and CORPs.
– Communication materials and resources for community education sessions.
– Distribution and availability of misoprostol at the community level.
– Monitoring and evaluation of the community mobilization efforts.
Please note that the provided information is based on the given description and may not include all the details from the original study.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides a clear description of the community mobilization intervention and its impact on the uptake of misoprostol for postpartum hemorrhage prevention. The use of multiple logistic regression adds to the strength of the analysis. However, the study is limited to five communities in northern Nigeria, which may affect the generalizability of the findings. To improve the strength of the evidence, future studies could consider expanding the sample size and including a control group for comparison.

The purpose of this study is to demonstrate the importance of community mobilization in the uptake of a health intervention, namely, community-based distribution of misoprostol to prevent postpartum hemorrhage. Community mobilization to increase access to misoprostol for postpartum hemorrhage prevention was implemented in northwestern Nigeria in 2009. Theories of community participation and the current near-epidemic maternal mortality conditions underpin an approach using modest levels of community involvement. The study was undertaken in five communities around Zaria, Nigeria. Community leaders and selected community members participated in a series of dialogs. Additionally, community education, information and dramas sessions were held. Twenty nine community oriented resource persons (CORPs), 27 drug keepers and 41 traditional birth attendants (TBAs) were involved in the intervention. Postpartum interviews were used to assess the impact of community mobilization efforts and to track use of misoprostol. Multiple logistic regression was used to examine the association between correct use and receiving information regarding misoprostol from TBAs or CORPs. A total of 1875 women were enrolled in the study in 2009. Most women delivered at home (95%) and skilled attendance at delivery was low (7%). Community mobilization efforts reached most women with information about postpartum hemorrhage and misoprostol (88%), resulting in high comprehension of intervention messages. Women identified TBAs and CORPs as the single most important source of information about misoprostol 41% and 31% of the time, respectively. Availability of misoprostol at the community level gave 79% of enrolled women some protection against postpartum hemorrhage which they otherwise would not have had. Although high level community participation in health care interventions is the ideal, this study suggests that even in circumstances where only modest levels of participation can realistically be achieved, community mobilization can have a significant impact on the successful distribution and uptake of a potentially life-saving health intervention, in turn helping promote policy change. © 2012 Elsevier Ltd.

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The study conducted in northern Nigeria demonstrated the effectiveness of community mobilization in improving access to maternal health, specifically in the distribution of misoprostol to prevent postpartum hemorrhage. The approach used in the study involved engaging community leaders, selected community members, traditional birth attendants, and community-oriented resource persons in dialogs, education sessions, and information dissemination.

The results showed that community mobilization efforts reached a high percentage of women with information about postpartum hemorrhage and misoprostol. Traditional birth attendants and community-oriented resource persons were identified as the most important sources of information about misoprostol. The availability of misoprostol at the community level provided protection against postpartum hemorrhage for a significant number of women who would not have had access otherwise.

Overall, the study suggests that community mobilization can have a significant impact on the successful distribution and uptake of a potentially life-saving health intervention, even with modest levels of community participation. This can help promote policy change and improve access to maternal health.
AI Innovations Description
The recommendation to improve access to maternal health is community mobilization. This involves actively engaging the community in the uptake of a health intervention, specifically the distribution of misoprostol to prevent postpartum hemorrhage. The study conducted in northern Nigeria demonstrated the effectiveness of community mobilization in increasing access to misoprostol.

The approach used in the study involved community leaders and selected community members participating in dialogs, as well as community education, information, and drama sessions. Community-oriented resource persons, drug keepers, and traditional birth attendants were also involved in the intervention.

The results showed that community mobilization efforts reached a high percentage of women with information about postpartum hemorrhage and misoprostol. Women identified traditional birth attendants and community-oriented resource persons as the most important sources of information about misoprostol.

The availability of misoprostol at the community level provided protection against postpartum hemorrhage for a significant number of women who would not have had access otherwise.

Overall, the study suggests that even with modest levels of community participation, community mobilization can have a significant impact on the successful distribution and uptake of a potentially life-saving health intervention. This can help promote policy change and improve access to maternal health.
AI Innovations Methodology
To simulate the impact of community mobilization on improving access to maternal health, you could consider the following methodology:

1. Selection of study sites: Choose a region or community with limited access to maternal health services, particularly in terms of preventing postpartum hemorrhage. Ensure that the selected sites have a sufficient number of home births and a lack of awareness about misoprostol.

2. Intervention design: Develop a community mobilization intervention plan based on the recommendations mentioned in the abstract. This may include engaging community leaders, conducting dialogs, organizing community education sessions, and involving traditional birth attendants, community-oriented resource persons, and drug keepers.

3. Implementation of the intervention: Implement the community mobilization intervention in the selected study sites. Ensure that the intervention is carried out consistently and according to the established plan.

4. Data collection: Conduct postpartum interviews with women who have given birth at home in the study sites. Collect information on their awareness and knowledge about postpartum hemorrhage, misoprostol, and the sources of information they rely on. Also, track the use of misoprostol among the participants.

5. Data analysis: Use multiple logistic regression to examine the association between correct use of misoprostol and receiving information from traditional birth attendants or community-oriented resource persons. Analyze the data to determine the impact of community mobilization efforts on increasing access to misoprostol and preventing postpartum hemorrhage.

6. Evaluation of results: Assess the effectiveness of the community mobilization intervention in improving access to maternal health. Evaluate the reach and comprehension of intervention messages, the percentage of women protected against postpartum hemorrhage, and the overall impact on policy change.

7. Dissemination of findings: Share the results of the study through publication in relevant journals or by presenting at conferences. This will contribute to the existing knowledge on the effectiveness of community mobilization in improving access to maternal health.

By following this methodology, you can simulate the impact of community mobilization on improving access to maternal health and contribute to the evidence base for implementing similar interventions in other settings.

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