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Programmes for advance distribution of misoprostol to prevent post-partum haemorrhage: a rapid literature review of factors affecting implementation

Smith, Helen, Colvin, Christopher J, Dusabe-Richards, Esther, Roberson, Jeffrey, Sharma, Geeta, Thapa, Kusum and Gülmezoglu, A Metin (2015) 'Programmes for advance distribution of misoprostol to prevent post-partum haemorrhage: a rapid literature review of factors affecting implementation'. Health Policy and Planning, Vol 31, Issue 1, pp. 102-113.

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Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synthesizes current knowledge about the barriers and facilitators affecting implementation of advance community distribution of misoprostol to prevent PPH, where misoprostol may be self-administered or administered by an LHW.

We searched for and summarized available empirical evidence, and collected primary data from programme stakeholders about their experiences of programme implementation.

We present key outcomes and features of advanced distribution programmes that are in operation or have been piloted globally. We categorized factors influencing implementation into those that operate at the health system level, factors related to the community and policy context and those factors more closely connected to the end user.

Debates around advance distribution have centred on the potential risks and benefits of making misoprostol available to pregnant women and community members during pregnancy for administration in the home. However, the risks of advance distribution appear manageable and the benefits of self-administration, especially for women who have little chance of expert care for PPH, are considerable.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 21.5 Allied health personnel. Allied health professions
QV Pharmacology > Drug Standardization. Pharmacognosy. Medicinal Plants > QV 748 Prescription writing. Dosage. Dosage calculations
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WQ Obstetrics > Labor > WQ 330 Complications of labor
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Jessica Jones
Date Deposited: 02 Feb 2016 16:27
Last Modified: 06 Feb 2018 13:11


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