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1. Barriers to the use of maternity waiting homes in indigenous regions of Guatemala: a study of users' and community members' perceptions

Author

Sandra G. García, Singh K, Fullerton J, Holston Mm, Chauhan K, Courtney Burks, A. Munguía, Sahoo Pk, Gubin R, Erim Do, Dibaba Y, Wajid A, Barry Dj, Maine D, Kwalombota K, M.J. Ruiz, Riley J, Karla Berdichevsky, Suchindran C, Brodish P, Prata N, Gull S, van Dijk Mg, Smith Jm, Mir Am, Raj Ss, Manthri S, McLaughlin Mm, Marumo L, P. Chetane, Mukherjee Js, Kimani M, Resch Sc, Kwonjune J. Seung, Satti H, Goldie Sj, and S. Motsamai

Subjects
Rural Population, Pediatrics, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Health (social science), media_common.quotation_subject, Pregnancy, High-Risk, Maternal-Child Health Centers, Fertility, Child health, Health Services Accessibility, Birth rate, Pregnancy, Medicine, Humans, Maternal health, Maternal Health Services, Qualitative Research, media_common, Child survival, business.industry, Public Health, Environmental and Occupational Health, Guatemala, Indians, Central American, Rural ethiopia, Child mortality, Maternal Mortality, Family planning, Female, business, Demography
Abstract

Maternal mortality among indigenous women in Guatemala is high. To reduce deaths during transport from far-away rural communities to the hospital, maternity waiting homes (MWH) were established near to hospitals where women with high-risk pregnancies await their delivery before being transferred for labour to the hospital. However, the homes are under-utilised. We conducted a qualitative study with 48 stakeholders (MWH users, family members, community leaders, MWH staff, Mayan midwives and health centre and hospital medical staff) in Huehuetenango and Cuilco to identify barriers before, during and after the women's stay in the homes. The women most in need - indigenous women from remote areas - seemed to have least access to the MWHs. Service users' lack of knowledge about the existence of the homes, limited provision of culturally appropriate care and a lack of sustainable funding were the most important problems identified. While the strategy of MWHs has the potential to contribute to the prevention of maternal (as well as newborn) deaths in rural Guatemala, they can only function effectively if they are planned and implemented with community involvement and support, through a participatory approach.

Published
2012

2. Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date.

Author

Smith JM, Gubin R, Holston MM, Fullerton J, and Prata N

Subjects
Developing Countries, Female, Humans, Maternal Mortality, Postpartum Hemorrhage epidemiology, Practice Guidelines as Topic, Pregnancy, Self Administration, World Health Organization, Community Health Workers education, Home Childbirth methods, Midwifery education, Misoprostol administration & dosage, Misoprostol adverse effects, Misoprostol supply & distribution, Oxytocics administration & dosage, Oxytocics adverse effects, Oxytocics supply & distribution, Postpartum Hemorrhage prevention & control
Abstract

Background: Hemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births., Methods: We conducted an integrative review of published research studies and evaluation reports from programs that distributed misoprostol at the community level for prevention of PPH at home births. We reviewed methods and cadres involved in education of end-users, drug administration, distribution, and coverage, correct and incorrect usage, and serious adverse events., Results: Eighteen programs were identified; only seven reported all data of interest. Programs utilized a range of strategies and timings for distributing misoprostol. Distribution rates were higher when misoprostol was distributed at a home visit during late pregnancy (54.5-96.9%) or at birth (22.5-83.6%), compared to antenatal care (ANC) distribution at any ANC visit (22.5-49.1%) or late ANC visit (21.0-26.7%). Coverage rates were highest when CHWs and traditional birth attendants distributed misoprostol and lower when health workers/ANC providers distributed the medication. The highest distribution and coverage rates were achieved by programs that allowed self-administration. Seven women took misoprostol prior to delivery out of more than 12,000 women who were followed-up. Facility birth rates increased in the three programs for which this information was available. Fifty-one (51) maternal deaths were reported among 86,732 women taking misoprostol: 24 were attributed to perceived PPH; none were directly attributed to use of misoprostol. Even if all deaths were attributable to PPH, the equivalent ratio (59 maternal deaths/100,000 live births) is substantially lower than the reported maternal mortality ratio in any of these countries., Conclusions: Community-based programs for prevention of PPH at home birth using misoprostol can achieve high distribution and use of the medication, using diverse program strategies. Coverage was greatest when misoprostol was distributed by community health agents at home visits. Programs appear to be safe, with an extremely low rate of ante- or intrapartum administration of the medication.

Published
2013
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