Community-Based Distribution of Misoprostol for the Prevention of ...

The evaluation revealed a very favorable policy environment for the misoprostol intervention. The supportive
involvement of the district and upazila program managers was noteworthy, though supervision and
monitoring visits could be further increased for further expansion of the intervention. This should be included
in the monthly workplan of district and upazila managers.
The following recommendations emerged from the evaluation findings and should be considered for further
expansion of the intervention:
1.
Distribution of misoprostol at the community level contributes to reducing maternal mortality due to PPH.
As such, this program should be continued and expanded in other parts of the country to help achieve
MDG-5. To plan and finance the activities related to misoprostol distribution, these should be included in
the next Five-Year Plan.
2.
a.
b.
c.
The training curriculum, leaflet, stickers, and “insert” explaining the misoprostol tablets need to be
reviewed, modified, and updated to address audience concerns. The materials need to be further
clarified, and additional messages could be included. The pictures could be modified, although it may
be challenging to convey the message and make the picture acceptable to religious groups and others.
There was some confusion regarding when to take the misoprostol tablets. Going forward, it is
recommended that the program include a very clear message (i.e., that women are advised to take
the tablets within five minutes after delivery of the baby, rather than “immediately after delivery”).
Furthermore, to avoid confusion, this message should be consistently communicated in all
materials-the training curriculum, flipchart, and leaflet: “Misoprostol tablets should be taken within
five minutes after the delivery of the baby, regardless of whether the placenta comes out.”
A balanced strategy should be used for communicating the side effects of misoprostol, comparing
them with the consequences of PPH. This should be done in interpersonal communication as well as
in the insert in the tablet strip. Based on this information, women and their companions can develop a
clearer understanding of the gravity of the consequences of PPH and whether the side effects will
cause them less suffering. It is also advisable to mention some remedies for the side effects and the
duration of each.
3.
4.
5.
6.
Offering field worker refresher training three months after the initial training would be helpful. The
refresher training will help the relevant program staff to refresh their knowledge of misoprostol, as well as
share their field experiences. Any confusion that emerged during their initial field work could be discussed
and resolved at this time. Considering the cost of formal training, on-site coaching could also be done as
an alternative to refresher training.
As a result of the strong role that dais/TBAs still play in conducting deliveries and advising women on
issues concerning delivery, it is important to always include the birth attendant in the interpersonal
communication session with the pregnant woman about the use of misoprostol.
The results of the courtyard meetings (Utthan Baithak) were mixed. Although field workers confirmed
that Utthan Baithak were conducted in every area, women did not always know about these meetings,
the meetings were small and informal, and their quality was not uniform. Going forward, emphasis should
continue to be placed on interpersonal communication, which has shown to be effective when used in
combination with the BCC materials and the introduction of use of mass media through TV.
Innovative approaches need to be thought out to ensure that pregnant women do not forget to take
misoprostol during delivery. One option could be a pictorial list with delivery preparation arrangements
to hang in the room where the woman will deliver. This list would include using the tablets.
Mayer Hashi project Community-Based Distribution of Misoprostol for the Prevention of PPH 25