Feasibility and acceptability of clean birth kits containing misoprostol for self-administration to prevent postpartum hemorrhage in rural Papua New Guinea

Lisa M Vallely; Primrose Homiehombo; Elizabeth Walep; Michael Moses; Marynne Tom; Angela Kelly-Hanku; Andrew Vallely; Eluo Nataraye; Caroline Ninnes; Glen D Mola; Chris Morgan; John M Kaldor; Handan Wand; Andrea Whittaker; Caroline S E Homer

doi:10.1016/j.ijgo.2015.10.018

Feasibility and acceptability of clean birth kits containing misoprostol for self-administration to prevent postpartum hemorrhage in rural Papua New Guinea

Int J Gynaecol Obstet. 2016 Jun;133(3):301-6. doi: 10.1016/j.ijgo.2015.10.018. Epub 2016 Feb 24.

Authors

Affiliations

¹ The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. Electronic address: lvallely@kirby.unsw.edu.au.
² Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
³ Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
⁴ The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
⁵ Eastern Highlands Provincial Health Authority, Goroka, Papua New Guinea.
⁶ Susu Mamas PNG, Mount Hagen, Papua New Guinea.
⁷ School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
⁸ Centre of International Health, Burnet Institute, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁹ The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
¹⁰ School of Social Sciences, Faculty of Arts, Monash University, Melbourne, VIC, Australia.
¹¹ Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney, NSW, Australia.

PMID: 26971258
DOI: 10.1016/j.ijgo.2015.10.018

Abstract

Objective: To determine the feasibility and acceptability of providing clean birth kits (CBKs) containing misoprostol for self-administration in a rural setting in Papua New Guinea.

Methods: A prospective intervention study was conducted between April 8, 2013, and October 24, 2014. Eligible participants were women in the third trimester of pregnancy who attended a prenatal clinic in Unggai Bena. Participants received individual instruction and were then given a CBK containing 600μg misoprostol tablets for self-administration following an unsupervised birth if they could demonstrate their understanding of correct use of items in the CBK. Data regarding the use and acceptability of the CBK and misoprostol were collected during postpartum follow-up.

Results: Among 200 participants, 106 (53.0%) had an unsupervised birth, and 99 (93.4%) of these women used the CBK. All would use the CBK again and would recommend it to others. Among these 99 women, misoprostol was self-administered by 98 (99.0%), all of whom would take the drug again and would recommend it to others.

Conclusion: The findings strengthen the case for community-based use of misoprostol to prevent postpartum hemorrhage in remote communities. Large-scale interventions should be planned to further evaluate impact and acceptability.

Keywords: Clean birth kit; Papua New Guinea; Postpartum hemorrhage; Rural and remote settings; Self-administered misoprostol; Unsupervised birth.

MeSH terms

Adult
Female
Home Childbirth / methods
Home Childbirth / statistics & numerical data*
Humans
Misoprostol / therapeutic use*
Oxytocics / therapeutic use*
Papua New Guinea
Postpartum Hemorrhage / prevention & control*
Practice Guidelines as Topic
Pregnancy
Prospective Studies
Rural Population
Self Administration / statistics & numerical data*
Young Adult

Substances

Oxytocics
Misoprostol