Background
Methods
Eligibility criteria
Type of study
Type of participants
Type of intervention
Type of outcome measures
Information sources
Search
Study selection
Data collection process and data items
Quality assessment
Summary measures
Synthesis of results
Results
Study selection
Study characteristics
Study (first author, year of publication) | Design | Location | Deliveries (N per group) | Population (age, parity, education)a | PPH (%) | RR (95% CI) |
---|---|---|---|---|---|---|
Misoprostolb, self- administered | ||||||
Geller et al., 2013 [22] | Quasi exp. trial | 30 communities in Ghana | 102 (82) misoprostol, 107 (92) control | Age: 26.6 ± 6.7 Parity(2–4): 46% Education: n/a | Misoprostol 1.2% (1/82), Control 3.3% (3/92) | 0.38 (0.04–3.57) |
Mir et al., 2012 [31] | Quasi exp. trial | Districts of Dadu and Khanewal, India | 678 (678) misoprostol, 720 (720) control | Age: 28 ± 5.7 Parity: n/a No education: 73% | Misoprostol (3/678) 0.4%, Control (n = 5/720) 0.6% | 0.42 (0.08–2.18) |
Misoprostol, TBAs | ||||||
Mobeen et al., 2010 [17] | RCT | 46 villages in Chitral, Pakistan | 533 (514) misoprostol, 583 (558) control | Age: 28 ± 5 Parity (3–5): 42.4% No education: 72.7% | Misoprostol 16.5% (85/514), Control 21.9% (122/558) | 0.76 (0.59–0.97) |
Prata et al., 2009 [32] | Quasi exp. trial | Rural villages of Tigray, Ethiopia | 485 (485) misoprostol, 481 (481) control | Age: 27.7 ± 6.7 Parity: 3.4 ± 2.0 No education: 80.2% | Misoprostol 8.9% (43/485), Control 18.9% (91/481) | 0.47 (0.33–0.66) |
Walraven et al., 2005 [11] | RCT | 26 villages of the North Bank East Health Division, The Gambia | 629 (629) misoprostol + 4 placebo tablets, 599 (599) ergometrinec + 3× placebo | Age: 25.9 ± 5.3 Parity(≥6): 18.6% No education: 95.2% | Misoprostol 11.0% (69/629), Ergometrine 12.0% (72/599) | 0.91 (0.67–1.25) |
Misoprostol, TBAs or self-administered | ||||||
Ejembi et al., 2014 [30] | Quasi exp. trial | 5 communities in North-West Nigeria | 1239 (1239) misoprostol, 231 (231) control | Age, parity, education: n/a | Misoprostol 8.1% (100/1239), Nothing 9.5% (22/231) | 0.84 (0.54–1.30) |
Prata et al., 2012a [33] | Quasi exp. trial | 5 communities in North-West Nigeria | 1421 (1421) misoprostol, 303 (303) control | Age, parity, education: n/a | Misoprostol 1.2% (17/1421) Nothing 7.6% (23/303) | 0.16 (0.09–0.31) |
Misoprostol, auxiliary midwives | ||||||
Chandhiok et al., 2005 [27] | Cluster-RCT | 30 PHCs from 5 states in India | 600 (600) misoprostol, 600 (600) standard (methergined/ nothing) | Age:24.3 ± 3.6, Gravida (2–3): 56.3%, Literate: 62% | Misoprostol 0.7% (4/600), Control 0.8% (5/600) | 0.80 (0.22–2.96) |
Derman et al., 2006 [28] | RCT | 4 PHCs of Belgaum district, India | 812 (809) misoprostol, 808 (807) placebo | Age:23.3 ± 3.3 Parity (1–2): 58.1% Literacy: 62.9% | Misoprostol 6.4% (52/809), Control 12.0% (97/807) | 0.53 (0.39–0.74) |
Oxytocine, auxiliary midwives | ||||||
Low et al., 2008 [34] | Quasi exp. trial | Public birth center in Morazan, Honduras | 146 (146) oxytocin, 83 (83) control | Age:23.5 Parity (1–4): 49.2% Education: n/a | Oxytocin 12.3% (18/146), No oxytocin 19.3% (16/83) | 0.64 (0.35–1.19) |
Low et al., 2012 [35] | Quasi exp. trial | Public birth center in Morazan, Honduras | 339 (339) intervention, 229 (229) pre-intervention | Age: 23.1 ± 6.5, Parity: 1.5 ± 2.1 Education: n/a | Intervention 5.9% (20/339), Pre-intervention 14.8% (34/229) | 0.40 (0.23–0.67) |
Misoprostol 2x200mcg, community health worker | ||||||
Nasreen et al., 2011 [36] | Quasi exp. trial | 2 districts, northern Bangladesh | 884 (884) misoprostol, 1008 (1008) control | Age:23.0 ± 4.8 Gravida: 2.6 ± 1.4 vs 2.1 ± 1.2 No education: 36.1% vs 21.2% | Misoprostol 1.6% (14/884), Control 6.4% (65/1008) | 0.25 (0.14–0.43) |
Oxytocin uniject device, community health worker | ||||||
Stanton et al., 2013 [29] | Cluster RCT | 4 rural districts in Brong-Ahafo region, Ghana | 689 (682) oxytocin 888 (888) control | Age: 27.5 ± 6.6. Parity(2–4): 43.3% No education: 48% | PPH-1:f 2.6% (18/682) vs 5.5% (49/887) PPH-2: 3.8% (26/682) vs 10.8% (96/887) PPH-3: 4.1% (28/682) vs 11.1% (99/888) Severe PPH 0.1% (1/682) vs 0.9% (8/887) | PPH-1: 0.49 (0.27–0.88) PPH-2: 0.34 (0.18–0.63) PPH-3: 0.36 (0.20–0.66) Severe PPH: 1 (0.013–1.7) |
Study (first author, year of publication) | Study Design | Location | Population (age, parity, education)a | Training of intervention | Intervention – what/whob | Distribution complete - % of deliveries | Intervention – correct dose and/or timing (%) | Intervention – acceptance (%) |
---|---|---|---|---|---|---|---|---|
Diadhiou et al., 2011 [37] | Quasi-exp. trial | health center/post and maternity huts in 2 districts, Senegal | Age: 26.4 ± 5.5 Parity: 2.9 ± 2.2 No education: 43% | 6 days course including 5 days on EoC and 1 day on misoprostol administrationc | Misoprostol
auxiliary midwives
| 16.1% (41/255) in Thies, 4.2% (9/214) in Kaolack, both percentages refer to distribution in maternity huts | Correct dose and timing: 100% (245/245) in HC/HP and MH | Recommended to friends: n/a Use at next delivery: n/a Willing to pay: 85.6% (160/187) in HC, 100% (8/8) in HP, 100% (50/50) in MH |
Ejembi et al., 2014 [30] | Quasi- exp. trial | 5 communities North-West Nigeria | Age, parity, education: n/a | TBAs: 6 days course on home-based EoC and misoprostol administration. Women: educated on misoprostol use at home visits of TBAs. | Misoprostol, distribution by drug keeper to TBA, self-administration, friend/relative, doctor/midwife | 80.2% (1265/1577), total group - TBA:88.1% (919/1043) - Self-administered: 66.3% (106/160) - Friend: 67.1% (147/219) - Midwife:46.1% (47/102) - Attendant unknown for 53 deliveries | - Total group: dose 93.2% (1179/1265), time 87.3% (1104/1265) - TBA: dose 96.2% (884/919), time 88.9% (817/919) - Self-administered: dose 96.2% (102/106), time 77.4% (82/106) - Friend: dose 95.9% (141/147), time 85% (125/147) - Midwife: dose 93.6% (44/47), time 78.7% (37/47) | Recommended to friends: 99.7% (1260/1264) Use at next delivery: 99.4% (1256/1264) Willing to pay: 99.1% (1253/1264) Post-delivery data for this topic is missing for n = 1 delivery |
Geller et al., 2014 [22] | Quasi- exp. trial | 30 communities in rural Ghana | Age: 24.4 ± 6.56 Parity: 2.5 ± 2.05 Education: n/a | Training of midwives and CHWs on misoprostol administration. Use of pictorial charts for women. | Misoprostol, self-administered | 65% (654/999) of misoprostol tablets distributed by midwives at antenatal care visits. N = 105 (96 at home, 9 institutional) women take misoprostol | Correct dose: n/a Correct timing: 98.9% (92/93) No data collected for institutional deliveries | Recommended to friends: 98.6% (71/72) Use at next delivery: 98.6% (71/72) Willing to pay: n/a Post-delivery data for this topic is missing for n = 21 deliveries |
Mir et al.,2012 [31] | Quasi-exp trial | Dadu and Khanewal districts, India | Age 28 ± 5.7 Parity: n/a No education: 73% | Creating of community awareness & family education regarding use of misoprostol. 1 month before delivery women were assessed retention of knowledge. 15 days before delivery again briefed on information | Misoprostol, self- administered | 88% (678/770) of women that delivered at home took misoprostol | Correct dose and timing: 95% (647/678) | Recommended to friends: 80% (616/770) Use at next delivery: 80% (616/770) Willing to pay: 74% (570/770) |
Prata et al., 2012a [33] | Quasi-exp trial | 5 rural communities North-West Nigeria. | Age, parity, education: n/a | TBAs were trained to counsel pregnant women about bleeding after delivery, the importance of delivery at a health facility, and the role of misoprostol and its administration. | Misoprostol, TBA or self-administration | 79% (1421/1800) of women that were interviewed postpartum took misoprostol | Correct dose: 98% (1393/1421) Correct time: 88% (1250/1421) | Recommendations, use at next delivery, willing to pay: n/a |
Prata et al., 2012b [38] | Quasi-exp trial | 6 rural districts in Bangladesh | Age, parity, education: n/a | Training concerning various aspects of misoprostol and the usage of a delivery mat to measure blood loss. | Misoprostol, RDRS trained and non-RDRS TBAs, self- administration, relative, nurse/doctor | RDRS-trained TBA: 81.3% (1041/1280) Non-RDRS TBA: 69.9% (533/762) Relative 64.8% (250/386) Alone 67.7% (44/65) Doctor 7.6% (18/236) Nurse 67.7% (44/65) | Correct dose: n/a -TBA (trained/untrained): time 99.9% (1572/1574) - other groups: time 99.7% (355/356) | Recommended to friends: 98.6% (1903/1930) Use at next delivery: n/a Willing to pay: 84.6% (1633/1930) All women that were offered misoprostol, independent of birth attendant |
Prata et al., 2014 [12] | Quasi-exp. trial | 6 rural districts of Rangpur Division, Bangladesh | Age (15–29): 89.3% No education: 63% Gravidity (2+): 67.6% | RDRS trained TBAs received 2 days training on administration of misoprostol. | Misoprostol, RDRS trained TBA, non-RDRS TBA, lay person | 67.4% (64.413/66489) RDRS trained TBA: 71% non-RDRS TBA 48% lay person 54% | Correct dose: n/a Correct time: n/a | Recommendations, use at next delivery, willing to pay: n/a |
Rajbhandariet al., 2010 [39] | Quasi-exp. trial | 30 clusters in 1 district in India, rural area. | Age: 25 yrs. Mean parity: 3; literate respondents: average 33% | Prenatal health education by female community health volunteers at home visits in 3–4 sessions. Other family members were involved. Advice on seeking prenatal care, planning institutional delivery, misoprostol, timely response to danger symptoms. | Misoprostol, self-administered | In study period (2006–2008) 74.5% (13969/18761) women took misoprostol. At end line of study 74% (604/816) of vaginal deliveries received misoprostol. 74% (447/604) of these women took misoprostol. | Correct dose: 98.2%(439/447) Correct time: 100% (447/447) | Recommendations, use at next delivery, willing to pay: n/a |
Sanghvi et al., 2010 [10] | Quasi-exp. trial | 8 districts in Afghanistan | Age: n/a Gravida > 1: 84.4% Education: n/a | Instructed by CHWs and SBAs during three home visits. Only received misoprostol when women were able to demonstrate understanding of the usage and risks. | Misoprostol, self-administered | 99% (2021/2039) of pregnant women were offered misoprostol, 97.5% (1970/2021) accepted the drug. 70% (1421/2039) of all pregnant women, took the drug. | Correct dose: 99.8% (1418/1421) Correct time: 95.8% (1361/1421) | Recommended to friends: 92% (1876/2039) Use at next delivery: n/a Willing to pay: 88% (1794/2039) |
Sibley et al., 2014 [5] | Quasi-exp. trial | 3 districts in Amhara and Oromiya regions of Ethiopia | Age 20-34 yrs.: 76.5% No education: 71.9% Parity 2–4: 51% | Facility based Community Maternal and Neonatal Health Extension Program - training, no further specification. | Misoprostol, health extension workers, CHWs, TBAs and self-administered | 58.9% (600/1019) of women received misoprostol. 97.5% (585/600) used it. | Correct dose and timing: 70.7% (412/585) Correct dose: 83.4% (483/585) Correct time: 84.1% (491/585) | Recommendations, use at next delivery, willing to pay: n/a |
Smith et al., 2014a [13] | Quasi-exp. trial | 2 districts in Grand Bassa county, Liberia | Age, parity, education: n/a | Explanation of misoprostol use to women at antenatal care visits or at home visits by district reproductive health supervisor. | Misoprostol, self-administered | 53.7% (980/1826) of all women received misoprostol. Of a sample of 550 women who received misoprostol 302 delivered at home, 87.7% (265/302) of them took the drug. | Correct dose: n/a Correct time: 63% (167/265) | Recommended to friends: 99.6% (258/259) Use at next delivery: 98.1% (254/259) Willing to pay: 54.6% (142/260) For some questionnaires data were missing. Data shown are independent of distributor of misoprostol |
Smith et al., 2014b [40] | Quasi-exp. trial | Mundri East County and South Sudan, Sudan | Age, parity, education: n/a | Education of misoprostol use to women at pre-natal care visits or home visits by SBAs and maternal health workers | Misoprostol, self-administered | 84.9% (787/927) of women received misoprostol during pregnancy. 98.9% (527/533) of women delivering at home received misoprostol. Postpartum data were gathered for 76.1% (599/787) of women of whom 81% (485/599) had home delivery with misoprostol. | Correct dose: n/a Correct time: 98.6% (478/485) | Recommended to friends: 95.1% (461/485) Use at next delivery: 99.0% (480/485) Willing to pay: 99.0% (480/485) |