Swallowing the pills
: scaling-up the use of misoprostol for the prevention of post-partum haemorrhage at home births in two provinces in Mozambique

  • Karen Hobday

    Student thesis: Doctor of Philosophy (PhD) - CDU


    Background: Post-partum haemorrhage (PPH) is a leading cause of Mozambique’s high maternal mortality. While injectable oxytocin can prevent PPH, 30% of births in Mozambique occur without a skilled birth attendant or access to oxytocin. Misoprostol is an alternative uterotonic in tablet form that can prevent PPH. In 2015, the Ministry of Health (MoH) commenced a program to distribute misoprostol at community level in 35 districts country-wide to reduce PPH in home births.

    Aim: The aim of the study was to identify facilitators and barriers influencing the scale-up of misoprostol for the prevention of PPH in two provinces of Inhambane and Nampula, Mozambique.

    Methods: This mixed methods study was conducted in 2016-2017 in partnership with the Mozambican MoH. The qualitative component adopted a phenomenological methodology and included in-depth interviews and focus group discussions. Quantitative data included frequencies and percentages of training and coverage data provided by the MoH.

    Findings: Scale-up involved facilitators and barriers. Facilitators included: a supportive environment; credible and relevant innovation; early expansion into some MoH systems and, a strong network of community health workers (CHW) and traditional birth attendants (TBA). Barriers included: select distribution; fear of misuse; limited communication surrounding the National PPH Strategy; inadequate monitoring and evaluation; challenges with logistics systems and the role of CHWs and TBAs. TBAs were satisfied with their role in the misoprostol program and were motivated to work alongside the formal health system. Women who used misoprostol were satisfied with the medication and encouraged wider access. Disparities existed between the coverage and access of misoprostol for PPH prevention in the provinces.

    Implications: The findings can assist government and maternal health stakeholders in Mozambique to better understand factors critical to introducing misoprostol at the community level and the complexities of scaling-up. Lessons learned may be applicable to other low to middle income countries.
    Date of AwardJun 2019
    Original languageEnglish
    SupervisorCaroline Homer (Supervisor) & Renae Kirkham (Supervisor)

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