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

Blami Dao(1), Fidele Ngabo(2), Jeremie Zoungrana(3), Barbara Rawlins(4), Beata Mukarugwiro(5), Pascal Musoni(6), Rachel Favero(7), Juliet MacDowell(8), Kanyamanza Eugene(9),


(1) Jhpiego 1615 Thames Street, Baltimore, MD 21231 USA
(2) Ministry of Health, Rwanda , P.O. Box 84 Kigali, Rwanda
(3) MCHIP, Jhpiego P.O.BOX 1680,Kigali, Kacyiru Sud, KG 684 Street Gate 19, Kigali, Rwanda
(4) MCHIP, 1776 Massachusetts Avenue, Suite 300, Washighton, DC 20036, USA
(5) MCHIP, Jhpiego P.O.BOX 1680,Kigali, Kacyiru Sud, KG 684 Street Gate 19, Kigali, Rwanda
(6) MCHIP, Jhpiego P.O.BOX 1680,Kigali, Kacyiru Sud, KG 684 Street Gate 19, Kigali, Rwanda
(7) Jhpiego 1615 Thames Street, Baltimore, MD 21231 USA
(8) Project Hope, 225 Carter Hall Line, Millwood VA 22646 USA
(9) Ministry of Health, Rwanda , P.O. Box 84 Kigali, Rwanda
Corresponding Author

Abstract


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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