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BMC Health Services Research

, 15:9

Health systems and services in low and middle income settings

Abstract

BackgroundPostpartum hemorrhage PPH is the leading cause of maternal mortality in developing countries. While incidence of PPH can be dramatically reduced by uterotonic use immediately following birth UUIFB in both community and facility settings, national coverage estimates are rare. Most national health systems have no indicator to track this, and community-based measurements are even more scarce. To fill this information gap, a methodology for estimating national coverage for UUIFB was developed and piloted in four settings.

MethodsThe rapid estimation methodology consisted of convening a group of national technical experts and using the Delphi method to come to consensus on key data elements that were applied to a simple algorithm, generating a non-precise national estimate of coverage of UUIFB. Data elements needed for the calculation were the distribution of births by location and estimates of UUIFB in each of those settings, adjusted to take account of stockout rates and potency of uterotonics. This exercise was conducted in 2013 in Mozambique, Tanzania, the state of Jharkhand in India, and Yemen.

ResultsAvailable data showed that deliveries in public health facilities account for approximately half of births in Mozambique and Tanzania, 16% in Jharkhand and 24% of births in Yemen. Significant proportions of births occur in private facilities in Jharkhand and faith-based facilities in Tanzania. Estimated uterotonic use for facility births ranged from 70 to 100%. Uterotonics are not used routinely for PPH prevention at home births in any of the settings. National UUIFB coverage estimates of all births were 43% in Mozambique, 40% in Tanzania, 44% in Jharkhand, and 14% in Yemen.

ConclusionThis methodology for estimating coverage of UUIFB was found to be feasible and acceptable. While the exercise produces imprecise estimates whose validity cannot be assessed objectively in the absence of a gold standard estimate, stakeholders felt they were accurate enough to be actionable. The exercise highlighted information and practice gaps and promoted discussion on ways to improve UUIFB measurement and coverage, particularly of home births. Further follow up is needed to verify actions taken. The methodology produces useful data to help accelerate efforts to reduce maternal mortality.

KeywordsUterotonic Estimation Postpartum hemorrhage PPH Delphi method UUIFB AbbreviationsAMTSLActive management of the third stage of labor

DHSDemographic and health survey

HMISHealth management information system

MCHIPMaternal and Child Health Integrated Program

MICSMultiple Indicator Cluster Survey

MOHMinistry of Health

NGONon-governmental organization

PPHPostpartum hemorrhage

SBASkilled birth attendant

UNFPAUnited Nations Population Fund

UUIFBUterotonic use immediately following birth

USAIDUnited States Agency for International Development

WHOWorld Health Organization

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Autor: Jim Ricca - Vikas Dwivedi - John Varallo - Gajendra Singh - Suranjeen Prasad Pallipamula - Nazir Amade - Maria de Luz Vaz

Fuente: https://link.springer.com/



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