Introduction of misoprostol for prevention of postpartum hemorrhage at the community level in Senegal

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Study Justification:
The study aimed to demonstrate that training auxiliary midwives in the correct administration of oral misoprostol can effectively prevent postpartum hemorrhage (PPH) among women giving birth at the community level in Senegal. This is important because timely management of PPH is crucial in reducing maternal mortality.
Highlights:
– A 6-day training program was conducted for auxiliary midwives and supervisors, including specific training on PPH prevention.
– Data collected between July and December 2009 showed that all participating women received the correct administration of oral misoprostol.
– However, it was found that few women delivering in community-based maternity huts received the required supervision for administering misoprostol.
– The study also revealed that women were willing to pay for some or all of the costs of misoprostol for PPH prevention.
Recommendations:
– Expand the training program to more auxiliary midwives and supervisors in Senegal to ensure widespread knowledge and correct administration of oral misoprostol.
– Strengthen the supervision and support system for auxiliary midwives in community-based maternity huts to ensure proper administration of misoprostol.
– Consider the feasibility of making misoprostol for PPH prevention more accessible and affordable for women in Senegal.
Key Role Players:
– Auxiliary midwives: They need to be trained in the correct administration of oral misoprostol and supported in their role.
– Supervisors: They play a crucial role in overseeing the work of auxiliary midwives and ensuring proper administration of misoprostol.
– Health centers and maternity huts: These facilities need to provide the necessary support and supervision for auxiliary midwives.
– Policy makers: They need to prioritize the implementation of training programs and the availability of misoprostol for PPH prevention.
Cost Items for Planning Recommendations:
– Training program: Costs associated with organizing and conducting the training for auxiliary midwives and supervisors.
– Supervision and support system: Resources needed to establish and maintain a system for supervising and supporting auxiliary midwives in community-based maternity huts.
– Accessibility and affordability of misoprostol: Consideration of the costs involved in making misoprostol more accessible and affordable for women in Senegal.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a training program for auxiliary midwives and collected data on the administration of oral misoprostol by trained midwives. All participating women received the correct administration of misoprostol. However, there is a limitation mentioned that few women delivering in community-based maternity huts received the required supervision. To improve the strength of the evidence, future studies could focus on addressing the supervision issue and include a larger sample size for more robust results.

Objective: To demonstrate that training ensures correct administration of oral misoprostol by auxiliary midwives for prevention of postpartum hemorrhage (PPH) among women giving birth at the community level in Senegal. Methods: A 6-day training program for auxiliary midwives and supervisors, including 1 day of PPH prevention training and a practicum of 10 deliveries at health centers and 3 deliveries at maternity huts, was conducted in 2 Senegalese districts in June-July 2009. Data were collected between July and December 2009 on the administration of oral misoprostol by trained auxiliary midwives among 245 women giving birth at health centers, health posts, and maternity huts. Results: All participating women received the correct administration of oral misoprostol; however, few women delivering in the community-based maternity huts received the supervision that is locally required to administer misoprostol. Women were willing to pay for some or all of the costs of misoprostol for PPH prevention. Conclusion: Timely management of PPH is essential to reduce maternal mortality. With limited training, auxiliary midwives achieved the correct administration of oral misoprostol that can attain this goal. Community delivery supervised by a skilled attendant limits access to, and need not be a requirement for, PPH prevention. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

The recommendation is to introduce misoprostol for the prevention of postpartum hemorrhage at the community level in Senegal. The objective is to demonstrate that training ensures the correct administration of oral misoprostol by auxiliary midwives for the prevention of postpartum hemorrhage among women giving birth at the community level in Senegal.

The recommendation suggests a 6-day training program for auxiliary midwives and supervisors, including 1 day of postpartum hemorrhage prevention training. The training program also includes a practicum of 10 deliveries at health centers and 3 deliveries at maternity huts. The data collected between July and December 2009 showed that all participating women received the correct administration of oral misoprostol. However, it was noted that few women delivering in community-based maternity huts received the required supervision to administer misoprostol.

The study concludes that timely management of postpartum hemorrhage is essential to reduce maternal mortality. With limited training, auxiliary midwives achieved the correct administration of oral misoprostol, which can help achieve this goal. The study also suggests that community delivery supervised by a skilled attendant may not be a requirement for postpartum hemorrhage prevention.

This recommendation, based on a study published in the International Journal of Gynecology and Obstetrics in 2011, highlights the potential of training auxiliary midwives and introducing misoprostol at the community level to improve access to maternal health and reduce maternal mortality.
AI Innovations Description
The recommendation to improve access to maternal health is the introduction of misoprostol for the prevention of postpartum hemorrhage at the community level in Senegal. The objective of this recommendation is to demonstrate that training ensures the correct administration of oral misoprostol by auxiliary midwives for the prevention of postpartum hemorrhage among women giving birth at the community level in Senegal.

The recommendation suggests a 6-day training program for auxiliary midwives and supervisors, including 1 day of postpartum hemorrhage prevention training. The training program also includes a practicum of 10 deliveries at health centers and 3 deliveries at maternity huts. The data collected between July and December 2009 showed that all participating women received the correct administration of oral misoprostol. However, it was noted that few women delivering in community-based maternity huts received the required supervision to administer misoprostol.

The study concludes that timely management of postpartum hemorrhage is essential to reduce maternal mortality. With limited training, auxiliary midwives achieved the correct administration of oral misoprostol, which can help achieve this goal. The study also suggests that community delivery supervised by a skilled attendant may not be a requirement for postpartum hemorrhage prevention.

This recommendation, based on the study published in the International Journal of Gynecology and Obstetrics in 2011, highlights the potential of training auxiliary midwives and introducing misoprostol at the community level to improve access to maternal health and reduce maternal mortality.
AI Innovations Methodology
The methodology used to simulate the impact of the main recommendations in this abstract on improving access to maternal health would involve the following steps:

1. Selection of study sites: Identify suitable districts or regions in Senegal where the introduction of misoprostol for prevention of postpartum hemorrhage (PPH) at the community level is feasible and relevant.

2. Training program development: Develop a comprehensive 6-day training program for auxiliary midwives and supervisors, including specific modules on PPH prevention. This program should cover theoretical knowledge, practical skills, and hands-on experience through a practicum of deliveries at health centers and maternity huts.

3. Training implementation: Conduct the training program in the selected districts, ensuring that all auxiliary midwives and supervisors receive the necessary training. Monitor and evaluate the training process to ensure its effectiveness and address any challenges or gaps.

4. Data collection: Collect data on the administration of oral misoprostol by trained auxiliary midwives among women giving birth at health centers, health posts, and maternity huts. This data should include information on the correct administration of misoprostol, supervision received, and willingness of women to pay for the costs of misoprostol.

5. Analysis of data: Analyze the collected data to assess the impact of the training program on improving access to maternal health. Evaluate the proportion of women who received correct administration of misoprostol, the level of supervision provided in community-based maternity huts, and the willingness of women to pay for misoprostol.

6. Interpretation of results: Interpret the findings to determine the effectiveness of the training program in ensuring the correct administration of misoprostol and improving access to maternal health. Assess the feasibility and implications of scaling up this intervention in other regions of Senegal.

7. Recommendations and policy implications: Based on the results and interpretation, provide recommendations for policymakers and stakeholders on the potential benefits of introducing misoprostol at the community level and the importance of training auxiliary midwives. Highlight the need for adequate supervision and potential cost-sharing mechanisms to ensure sustainability.

By following this methodology, researchers can simulate the impact of the recommendations from the abstract and provide evidence-based insights to guide decision-making and improve access to maternal health in Senegal.

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