1. 1 Long-Term Community Use of Misoprostol Kigoma, Tanzania Ndola Prata University of California, Berkeley Venture Strategies for Health and Development 1

2. 2 Long-Term Community Use of Misoprostol Study Evaluate the long-term use of misoprostol to treat PPH during home births, including: –Exposure & comprehension of PPH & Miso –Use, safety and acceptability of misoprostol –Willingness to pay for misoprostol 2

3. Study Population Births between August 2004 and May 2007 n = 3519 Intervention Area Births n = 1829 Sample Population Questionnaires Administered n = 449 Completed Questionnaires n = 443 Non-intervention Area Births n = 1690 Sample Population Questionnaires Administered n = 509 Completed Questionnaires n = 507

4. 4 Interviewers Meeting the TBAs

5. 5 Qualitative data 32 In-Depth Interviews –Mothers: 19 –TBAs: 7 –Health Providers: 5 Focus Groups –Community Leaders (Intervention and non- Intervention) –TBAs (Intervention and non- Intervention) –Health Providers Review of facility data on referrals and adverse events Review of community registry of maternal deaths

6. 6 Knowledge of PPH and Misoprostol 6 Intervention (N=443) Non- intervention (N=507) Total (N=950) Received PPH information 78.6%77.7%78.1% Received misoprostol information 45.9%1.0%21.9% Received misoprostol information-among those who took the drug (N=164) 88.4%n/a

7. 7 Sources of Misoprostol Information

8. 8 Measurement of Bleeding Intervention (N=442) Non- intervention (N=502) Less than 2 kangas43.7%67.7% 2 or more kangas54.0%30.9% Don’t know/Can’t remember2.3%1.4%

9. 9 Use of Misoprostol among TBA assisted deliveries Women with perceived PPH (N=201) Women offered misoprostol (N=171) 85% Women accepted misoprostol (N=151) 88% Women who took misoprostol and needed to be transferred for additional interventions (N=3) 2%

10. 10 Side Effects among those who took misoprostol (n=161)

11. 11 Referrals Intervention N=442 Non- intervention N=507 Total Referrals15(3.4%)111 (21.9%) Reasons for Referral (no. women) Prolonged Labor 54 Excessive Bleeding 6101 Other reasons 47 Reasons related to side effects 00 23

12. 12 Acceptability Intervention N=442 Non- intervention N=507 Would recommend misoprostol to a friend 74.4%*85.2% Would take misoprostol if got PPH in future 82.8%88.4% Would take a drug to prevent PPH 87.1%*93.5% Would purchase misoprostol 82.1%*89.7%

13. 13 “Bring more! Bring more tablets!” –Response of a mother after the interviewer introduced himself as part of a misoprostol study Field Notes, Martine Holston Research Assistant 13

14. 14 Willingness to Pay for Misoprostol

15. 15 Willingness to pay for Misoprostol

16. 16 Lessons from the field No indication of misuse No evidence of increased morbidity/mortality No evidence of increased home deliveries “Kanga” continues to be used as a tool for referral and drug administration Miso can effectively and safely be administered by CHW trained in its use Women remember PPH & miso messages High level of acceptability and WTP –Subsidies might be needed ANC: untapped resource for PPH & miso information

17. 17 Acknowledgements Maweni Hospital, Kigoma, Tanzania Funding & commodities procurement: Technical assistance: 17 Bixby Program in Population, Family Planning & Maternal Health University of California, Berkeley