June 24, 2011

Community-level PPH prevention results met with Mozambique Ministry approval

(MAPUTO, MOZAMBIQUE) - On June 22, 2011, VSI, the Mozambican Association of Obstetricians and Gynecologists (AMOG) and the Bixby Center for Population, Health and Sustainability at the University of California, Berkeley shared the results of an operations research project introducing the essential medicine misoprostol to address the country’s leading cause of maternal death, postpartum hemorrhage (PPH).

VSI, AMOG and the Bixby Center at UC Berkeley designed the research project to increase women’s protection from PPH in rural areas, where the majority of women deliver at home without skilled care. Population Services International supported the development of materials for community and provider sensitization on the project. Over 12 months in three districts (Namacurra, Chokwé and Nacala-Porto/Nacala-a-Velha), misoprostol tablets were distributed to women at antenatal care (ANC) visits and for the first time in Mozambique, by traditional birth attendants (TBAs) equipped with knowledge and medicine to prevent life-threatening bleeding after childbirth at the community level.

At the national dissemination meeting, the project’s co-principal investigators Dr. Ndola Prata, VSI Medical and Programs Director, Associate Professor in Residence at UC Berkeley and Scientific Director for the Bixby Center, and Dr. Cassimo Bique, Senior Technical Advisor, VSI-Mozambique and Consultant Obstetrician/Gynecologist at Maputo’s Jose Macamo Hospital, presented the project methods and results, respectively. Overall, 99% of births among women interviewed in Chokwé and Nacala-Porto/Nacala-a-Velha districts were protected from PPH with misoprostol or another uterotonic drug, whether they delivered at home or at a clinic. Traditional birth attendants used misoprostol in all of the deliveries they attended in Namacurra, thereby providing protection from PPH among women who would otherwise have none. For more results, read the project brief here.

In addition to the scientific presentations, the meeting featured providers' experiences in the project. One TBA sang in Portuguese, “Three tablets of misoprostol after delivery to prevent hemorrhage; three tablets of misoprostol to save the life of a mother.” Her voice filled the room, and doctors, nurses, program planners and Ministry of Health (MOH) representatives began to hum along with her infectious rhythm.

The Ministry of Health representative, Dr. Leonardo Chavane, expressed the MOH’s support, stating “On behalf of the Ministry, we are committed to this project and to addressing postpartum hemorrhage in Mozambique.” Following the dissemination meeting, the MOH’s executive cabinet approved a staged approach to expanding the use of misoprostol for PPH prevention throughout the country, with an emphasis on applying the distribution strategy that will best address the delivery characteristics in each district.

Mozambique experiences a high rate of maternal mortality with more than 1,500 women dying each year. As part of its efforts to achieve the Millennium Development Goal of reducing maternal mortality by 75%, the Ministry of Health approved the registration of misoprostol tablets for management of PPH in 2009, and subsequently called for research to inform national policy on provision of the tablets to expectant mothers.

In addition to this program in Mozambique, VSI has worked with partners to introduce misoprostol for maternal health in 14 other countries, the majority in the African region. 

Read more about VSI’s work in Mozambique.

To LISTEN to more about this project and interviews with TBAs, check out this National Public Radio feature.