Increasing Access to Prevention of Postpartum Hemorrhage Interventions for Births in Health Facilities and at Home in Four Districts of Rwanda

Blami Dao, Fidele Ngabo, Jeremie Zoungrana, Barbara Rawlins, Beata Mukarugwiro, Pascal Musoni, Rachel Favero, Juliet MacDowell, Kanyamanza Eugene


To assess coverage, acceptability, and feasibility of a program to prevent postpartum hemorrhage (PPH) at community and facility levels, a study was conducted in 60 health facilities and their catchment areas in four districts in Rwanda. A total of 220 skilled birth attendants at these facilities were trained to provide active management of the third stage of labor and 1994 community health workers (ASMs) were trained to distribute misoprostol at home births. A total of 4,074 pregnant women were enrolled in the program (20.5 % of estimated deliveries). Overall uterotonic coverage was 82.5%: 85% of women who delivered at a facility received a uterotonic to prevent PPH; 76% of women reached at home at the time of birth by an ASM ingested misoprostol—a 44.3% coverage rate. Administration of misoprostol at the time of birth for home births achieved moderate uterotonic coverage. Advancing the distribution of misoprostol through antenatal care services could further increase coverage.

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National Institute of Statistics of Rwanda (NISR),

Ministry of Health (MOH) [Rwanda], and ICF International. 2012. Rwanda Demographic and Health Survey 2010. Calverton, Maryland, USA: NISR, MOH, and ICF International.

Khan K, Wojdyla D, Say L, Gulmezolglu AM and Van

Look P. WHO analysis of causes of maternal death: a systematic review. Lancet 2006, 367:1066-74.

MOH. Rwanda annual health statistics booklet 2012.

Available at: http://www. in/ templates/MOH-Reports/MOH_Booklet_2012_ final_September_2013.pdf. Accessed on April 18, 2014.

World Health Organization (WHO). WHO

recommendations for the prevention and treatment of postpartum haemorrhage. Geneva:WHO;2012. Available at: vehealth/ publications/maternal_perinatal_health

/9789241548502/en/. Accessed June 17, 2014.

Hofmeyr GJ, Gülmezoglu AM, Novikova N, Linder V,

erreira S and Piaggio G. Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and

dose-related effects. Bull World Health Organ.

; 87(9):666-77.

Smith JM, Gubin R, Holston M, Fullerton J and Prata N.

Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date. BMC Pregnancy and Childbirth 2013; 13:44 doi:10.1186/1471-2393-13-44.

The Partnership for Maternal, Newborn and Child

Health. Opportunities for Africa‘s Newborns. Practical data, policy and programmatic support for newborn care in Africa.2007.Available from: Accessed June 17, 2014.

Maternal and Child Health Integrated Program (MCHIP).

Postnatal Care Home Visits: A Review of the Current Status of Implementation in Five Countries. 2012. Available at: fault/files /Postnatal Care Home Visits.pdf.

Oladapo OT, Fawole B, Blum J andAbalos E. Advance

misoprostol distribution for preventing and treating postpartum haemorrhage. Cochrane Database of Systematic Reviews 2012, Issue 2. Art.No.:CD009336.DOI:10.1002/14651858.CD009336.pub2.

Hundley V, Avan B, Sullivan C and Graham W. Should

oral misoprostol be used to prevent postpartum haemorrhage in home-birth settings in low-resource countries? A systematic review of the evidence. BJOG 2012; DOI: 10.1111/1471-0528.12049.

Sanghvi H, Ansari N, Prata NJ, Gibson H, Ehsan AT

and Smith JM. Prevention of postpartum hemorrhage at home birth in Afghanistan. International Journal of Gynecology & Obstetrics 2010; 108(3):276–81.


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