As a summer intern with the Bixby Center for Population, Health and Sustainability, I will be working working in collaboration with Venture Strategies and the Ministry of Health, Zambia (MOHZ) to implement a formative midterm evaluation of a misoprostol pilot project that was rolled out in January 2009, aimed at reducing maternal death from post partum hemmorhaging (PPH). Based at the MOHZ, I will also be traveling to the five districts where the project is being piloted. During the three months in-country, I will be collecting data and assessing all areas of the project implemention, from the project management at MOHZ to the distribution of misoprostol within rural communities, then writing project recommendations upon completion of the evaluation.
The generic drug misoprostol has been very successful in both the prevention and treatment of PPH. As a low-cost, easy-to-administer uterotonic with a long shelf-life, misoprostol has the potential to reduce death and morbidity from PPH in home-deliveries without a skilled birth attendant. Recognizing misoprostol’s life-saving potential in low-income rural areas with limited access to formal health care, Venture Strategies is working closely with MOH in several countries to determine the best methods and routes for making it available. (Global Misoprostol Registration by Indication)
Misoprostol Pilot Project, Zambia
The goal of the Zambia project is to save mothers' lives by preventing PPH at home births with misoprostol tablets for women who are unable to reach a facility to deliver. The Zambian Pharmaceutical Regulatory Authority approved misoprostol, a simple tablet that can effectively prevent and control postpartum bleeding, for PPH prevention and treatment in May 2008. To reduce the number of women who die due to excessive bleeding at home births, this project will distribute misoprostol tablets at antenatal care (ANC) visits to women who cannot reach a facility to deliver.
The pilot project will provide evidence to inform policy decision makers on the use of misoprostol at home births dispersed through ANC visits, and can serve as a model for other regions of Zambia where most women deliver without a skilled attendant. The project aims to assist the Ministry of Health in developoing a distribution strategy that can be integrated into existing maternal health initiatives and scaled up to increase impact.
Why is this project so important?
The risk of maternal death from childbirth represents one of the greatest inequities in global health. Women in developing countries are more than 40 times more likely than women in developed countries to die in childbirth (1 in 61 women in developing countries versus 1 in 2,800 women in developed countries). Obstetric hemorrhage is the world’s leading cause of maternal mortality. Postpartum hemorrhage (PPH) is the most common type of obstetric hemorrhage and accounts for a quarter of maternal deaths worldwide -- in Zambia PPH attributes to over a third of maternal deaths. Maternal mortality in Zambia is 750 deaths per 100,000 live births (WHO, 2000). Women who carry a pregnancy beyond 20 weeks' gestation are at risk for PPH and its sequelae.
Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Developing countries lack the necessary drugs and skilled attendance during home births to manage PPH cases. In addition, the high prevalence of anemia among women in developing countries predisposes women to PPH-attributed mortality, as even the modest blood loss after delivery can be life threatening. To effectively manage PPH in resource poor settings where most women deliver at home, technologies such as misoprostol are the only available alternative. Thus, the need for empirical data to support community-based distribution and use of misoprostol is urgently needed.