Integrated Community Approach for the Prevention of Postpartum Hemorrhage and Newborn Infection in Madagascar

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Madagascar has a high maternal and neonatal mortality rate (478 per 100,000 live births and 21 per 1,000 live births respectively (WHO, 2013), with postpartum hemorrage as the leading cause of maternal death and infection as a leading cause of neonatal death. The study objective was to determine acceptability and feasibility in home births of administration of a uterotonic (misoprostol) for prevention of postpartum hemorrhage and chlorhexidine (CHX) gel 7.1% to newborn cord stumps to prevent infection through a community-based and health–facility-supported distribution scheme.

Methodology: An integrated PPH and neonatal infection curriculum was used to train 350 community health workers (CHW). Primary data included a questionnaire regarding acceptibility of the products.

Results: During home visits, CHW distributed misoprostol to 1937 women, regardless of the gestity at 32+ weeks of pregnancy, and CHX to 1872 women. CHWs educated women about danger signs, self-administration of misoprostol and use of CHX, while encouraging facility based delivery. 96% of CHW were trained in PPH prevention using misoprostol and newborn infection prevention using CHX 7.1%. 98% of women who received misoprostol took it appropriately after birth and before the placenta was expelled. Mother or family member appropriately administered CHX to 83% of newborns. Both miso (98%) and CHX (78%) were used appropriately by 77% of mother-newborn pairs. Satisfaction was high; 99% of women reported that they would use misoprostol in the future and had similar perceptions of clean cord practices with CHX.

Conclusions: An integrated program resulted in high and appropriate use of uterotonic and cord care by women who gave birth in the home. Based on the successful pilot, the MoH and Partners are planning to scale up the integrated approach to prevent PPH and neonatal infection as a strategy to accelerate the reduction of maternal and newborn deaths.