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Published in: Reproductive Health 1/2018

Open Access 01-12-2018 | Research

“My job is to get pregnant women to the hospital”: a qualitative study of the role of traditional birth attendants in the distribution of misoprostol to prevent post-partum haemorrhage in two provinces in Mozambique

Published in: Reproductive Health | Issue 1/2018

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Abstract

Background

Post-partum haemorrhage is the leading cause of maternal deaths in Mozambique. In 2015, the Mozambican Ministry of Health launched the National Strategy for the Prevention of Post-Partum Haemorrhage at the Community Level. The strategy included the distribution of misoprostol to women in advance at antenatal care and via Traditional Birth Attendants who directly administer the medication. The study explores the role of Traditional Birth Attendants in the misoprostol program and the views of women who used misoprostol to prevent post-partum haemorrhage.

Methods

This descriptive study collected data through in-depth interviews and focus group discussions. Traditional Birth Attendants between the ages of 30–70 and women of reproductive age participated in the study. Data was collected between June–October 2017 in Inhambane and Nampula Provinces. Line by line thematic analysis was used to interpret the data using Nvivo (v.11).

Results

The majority of TBAs in the study were satisfied with their role in the misoprostol program and were motivated to work with the formal health system to encourage women to access facility based births. Women who used misoprostol were also satisfied with the medication and encouraged family and friends to access it when needed. Women in the community and Traditional Birth Attendants requested assistance with transportation to reach the health facility to avoid home births.

Conclusions

This study contributes to the evidence base that Traditional Birth Attendants are an appropriate channel for the distribution of misoprostol for the prevention of post-partum haemorrhage at the community level. More support and resources are needed to ensure Traditional Birth Attendants can assist women to have safe births when they are unable to reach the health facility. A consistent supply of misoprostol is needed to ensure women at the community level receive this life saving medication.
Literature
1.
go back to reference WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations population division. Geneva: WHO; 2015. WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations population division. Geneva: WHO; 2015.
2.
go back to reference Ministério da Saúde (MISAU). Health Sector Strategic Plan PESS 2014-2019. Maputo: MISAU; 2014. Ministério da Saúde (MISAU). Health Sector Strategic Plan PESS 2014-2019. Maputo: MISAU; 2014.
3.
go back to reference David E, Machungo F, Zanconato G, Cavaliere E, Fiosse S, Sululu C, Chiluvane B, Bergström S. Maternal near miss and maternal deaths in Mozambique: a cross-sectional, region-wide study of 635 consecutive cases assisted in health facilities of Maputo province. BMC Pregnancy and Childbirth. 2014;14:401.CrossRef David E, Machungo F, Zanconato G, Cavaliere E, Fiosse S, Sululu C, Chiluvane B, Bergström S. Maternal near miss and maternal deaths in Mozambique: a cross-sectional, region-wide study of 635 consecutive cases assisted in health facilities of Maputo province. BMC Pregnancy and Childbirth. 2014;14:401.CrossRef
4.
go back to reference Alkema L, Chou D, Gemmill A, Hogan D, Mathers C, Mills S, Moller AB, Say L, Suzuki E. Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations population division. Geneva: WHO; 2014. Alkema L, Chou D, Gemmill A, Hogan D, Mathers C, Mills S, Moller AB, Say L, Suzuki E. Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations population division. Geneva: WHO; 2014.
5.
go back to reference Ministerio da Saude Moçambique (MISAU), Instituto Nacional de Estatística Moçambique (INE) and ICF International. Inquérito de Indicadores de Imunização, Malária e HIV/SIDA em Moçambique 2015. Maputo and Rockville: INS, INE and ICF International; 2016. Ministerio da Saude Moçambique (MISAU), Instituto Nacional de Estatística Moçambique (INE) and ICF International. Inquérito de Indicadores de Imunização, Malária e HIV/SIDA em Moçambique 2015. Maputo and Rockville: INS, INE and ICF International; 2016.
6.
go back to reference Schwitters A, Lederer P, Zilversmit L, Gudo PS, Ramiro I, Cumba L, Mahagaja E, Jobarteh K. Barriers to health care in rural Mozambique: a rapid ethnographic assessment of planned Mobile health clinics for ART. Glob Health Sci Pract. 2015;3(1):109–16.CrossRef Schwitters A, Lederer P, Zilversmit L, Gudo PS, Ramiro I, Cumba L, Mahagaja E, Jobarteh K. Barriers to health care in rural Mozambique: a rapid ethnographic assessment of planned Mobile health clinics for ART. Glob Health Sci Pract. 2015;3(1):109–16.CrossRef
7.
go back to reference Munguambe K, Boene H, Vidler M, Bique C, Sawchuck D, Firoz T, Makanga PT, Qureshi R, Macete E, Menendez C, et al. Barriers and facilitators to health care seeking behaviours in pregnancy in rural communities of southern Mozambique. Reprod Health. 2016;13(Suppl 1):31.CrossRef Munguambe K, Boene H, Vidler M, Bique C, Sawchuck D, Firoz T, Makanga PT, Qureshi R, Macete E, Menendez C, et al. Barriers and facilitators to health care seeking behaviours in pregnancy in rural communities of southern Mozambique. Reprod Health. 2016;13(Suppl 1):31.CrossRef
8.
go back to reference UNICEF. The state of the world's children 2009: maternal and newborn health. New York: UNICEF; 2009. UNICEF. The state of the world's children 2009: maternal and newborn health. New York: UNICEF; 2009.
9.
go back to reference World Health Organization. Making pregnancy safer: the critical role of the skilled attendant a joint statement by WHO, ICM and FIGO. Geneva: WHO; 2004. World Health Organization. Making pregnancy safer: the critical role of the skilled attendant a joint statement by WHO, ICM and FIGO. Geneva: WHO; 2004.
10.
go back to reference Darmstadt GL, Lee ACC, Cousens S, Sibley L, Bhutta ZA, Donnay F, Osrin D, Bang A, Kumar V, Wall SN, et al. 60 million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths. Int J Gynaecol Obstet. 2009;107(Suppl 1):S89–112.CrossRef Darmstadt GL, Lee ACC, Cousens S, Sibley L, Bhutta ZA, Donnay F, Osrin D, Bang A, Kumar V, Wall SN, et al. 60 million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths. Int J Gynaecol Obstet. 2009;107(Suppl 1):S89–112.CrossRef
11.
go back to reference Sibley LM, Sipe TA, Koblinsky M. Does traditional birth attendant training increase use of antenatal care? a review of the evidence. J Midwifery Womens Health. 2004;49(4):298–305.CrossRef Sibley LM, Sipe TA, Koblinsky M. Does traditional birth attendant training increase use of antenatal care? a review of the evidence. J Midwifery Womens Health. 2004;49(4):298–305.CrossRef
12.
go back to reference Bergström S, Goodburn E. The role of traditional birth attendants in the reduction of maternal mortality. In: De Brouwere V, Lerberghe V, editors. Safe motherhood strategies: a review of the evidence, studies in health services organization and policy. Volume 17. Antwerp: ITG Press; 2001. Bergström S, Goodburn E. The role of traditional birth attendants in the reduction of maternal mortality. In: De Brouwere V, Lerberghe V, editors. Safe motherhood strategies: a review of the evidence, studies in health services organization and policy. Volume 17. Antwerp: ITG Press; 2001.
13.
go back to reference Prata N, Passano P, Rowen T, Bell S, Walsh J, Potts M. Where there are (few) skilled birth attendants. J Health Popul Nutr. 2011;29(2):81–91.CrossRef Prata N, Passano P, Rowen T, Bell S, Walsh J, Potts M. Where there are (few) skilled birth attendants. J Health Popul Nutr. 2011;29(2):81–91.CrossRef
14.
go back to reference Gloyd S, Floriano F, Seunda M, Chadreque MA, Nyangezi JM, Platas A. Impact of traditional birth attendant training in Mozambique: a controlled study. J Midwifery Womens Health. 2001;46(4):210–6.CrossRef Gloyd S, Floriano F, Seunda M, Chadreque MA, Nyangezi JM, Platas A. Impact of traditional birth attendant training in Mozambique: a controlled study. J Midwifery Womens Health. 2001;46(4):210–6.CrossRef
15.
go back to reference Ministerio da Saude Moçambique (MISAU). National Plan for Health Human Resources Development (NPHHRD) 2008-2015. Edited by Institute of Hygiene and Tropical Medicine L, Portugal, The National Health Institute, Human Resource Directorate, School of Medicine in Maputo. Maputo: Ministry of Health National Directorate of Human Resources; 2008. Ministerio da Saude Moçambique (MISAU). National Plan for Health Human Resources Development (NPHHRD) 2008-2015. Edited by Institute of Hygiene and Tropical Medicine L, Portugal, The National Health Institute, Human Resource Directorate, School of Medicine in Maputo. Maputo: Ministry of Health National Directorate of Human Resources; 2008.
16.
go back to reference Libombo A, Bique C, da Luz VM, Jamisse L, Reis V, David E, Chavane L, Carbonell A, Modan A, Amade N. Strategy for the prevention of postpartum hemorrhage at the community level. Maputo: Republic of Mozambique Ministry of Health; 2013. Libombo A, Bique C, da Luz VM, Jamisse L, Reis V, David E, Chavane L, Carbonell A, Modan A, Amade N. Strategy for the prevention of postpartum hemorrhage at the community level. Maputo: Republic of Mozambique Ministry of Health; 2013.
17.
go back to reference Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, Patted SS, Patel A, Edlavitch SA, Hartwell T, et al. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet. 2006;368(9543):1248–53.CrossRef Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, Patted SS, Patel A, Edlavitch SA, Hartwell T, et al. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet. 2006;368(9543):1248–53.CrossRef
18.
go back to reference Walraven G, Blum J, Dampha Y, Sowe M, Morison L, Winikoff B, Sloan N. Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial. Int J Obstet Gynaecol. 2005;112(9):1277–83.CrossRef Walraven G, Blum J, Dampha Y, Sowe M, Morison L, Winikoff B, Sloan N. Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial. Int J Obstet Gynaecol. 2005;112(9):1277–83.CrossRef
19.
go back to reference Mobeen N, Durocher J, Zuberi N, Jahan N, Blum J, Wasim S, Walraven G, Hatcher J. Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirths in Pakistan: a randomised placebo-controlled trial. Int J Obstet Gynaecol. 2011;118(3):353–61.CrossRef Mobeen N, Durocher J, Zuberi N, Jahan N, Blum J, Wasim S, Walraven G, Hatcher J. Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirths in Pakistan: a randomised placebo-controlled trial. Int J Obstet Gynaecol. 2011;118(3):353–61.CrossRef
20.
go back to reference Prata N, Ejembi C, Fraser A, Shittu O, Minkler M. Community mobilization to reduce postpartum hemorrhage in home births in northern Nigeria. Soc Sci Med. 2012;74(8):1288–96.CrossRef Prata N, Ejembi C, Fraser A, Shittu O, Minkler M. Community mobilization to reduce postpartum hemorrhage in home births in northern Nigeria. Soc Sci Med. 2012;74(8):1288–96.CrossRef
21.
go back to reference Diadhiou M, Dieng T, Ortiz C, Mall I, Dione D, Sloan NL. Introduction of misoprostol for prevention of postpartum hemorrhage at the community level in Senegal. Int J Obstet Gynaecol. 2011;115(3):251–5.CrossRef Diadhiou M, Dieng T, Ortiz C, Mall I, Dione D, Sloan NL. Introduction of misoprostol for prevention of postpartum hemorrhage at the community level in Senegal. Int J Obstet Gynaecol. 2011;115(3):251–5.CrossRef
22.
go back to reference Dao B, Ngabo F, Zoungrana J, Rawlins B, Mukarugwiro B, Musoni P. Increasing access to prevention of postpartum hemorrhage interventions for births in health facilities and at home in four districts of Rwanda. Afr J Reprod Health. 2015;15(4):58–67. Dao B, Ngabo F, Zoungrana J, Rawlins B, Mukarugwiro B, Musoni P. Increasing access to prevention of postpartum hemorrhage interventions for births in health facilities and at home in four districts of Rwanda. Afr J Reprod Health. 2015;15(4):58–67.
23.
go back to reference Bell S, Passano P, Bohl DD, Islam A, Prata N. Training traditional birth attendants on the use of misoprostol and a blood measurement tool to prevent postpartum haemorrhage: lessons learnt from Bangladesh. J Health Popul Nutr. 2014;32(1):118–29.PubMedPubMedCentral Bell S, Passano P, Bohl DD, Islam A, Prata N. Training traditional birth attendants on the use of misoprostol and a blood measurement tool to prevent postpartum haemorrhage: lessons learnt from Bangladesh. J Health Popul Nutr. 2014;32(1):118–29.PubMedPubMedCentral
24.
go back to reference Vallely L, Homiehombo P, Walep E, Moses M, Tom M, Kelly-Hanku A, Andrew V, Nataraye E, Ninnes C, Mola GD, et al. Feasibility and acceptability of clean birth kits containing misoprostol for self-administration to prevent postpartum hemorrhage in rural Papua New Guinea. Int J Gynaecol Obstet. 2016;133(3):301-6. doi.org/10.1016/j.ijgo.2015.10.018.CrossRef Vallely L, Homiehombo P, Walep E, Moses M, Tom M, Kelly-Hanku A, Andrew V, Nataraye E, Ninnes C, Mola GD, et al. Feasibility and acceptability of clean birth kits containing misoprostol for self-administration to prevent postpartum hemorrhage in rural Papua New Guinea. Int J Gynaecol Obstet. 2016;133(3):301-6. doi.​org/​10.​1016/​j.​ijgo.​2015.​10.​018.CrossRef
26.
go back to reference Bique C, Prata N, Holston M, Moran M, Weinrib R. Community-based prevention of postpartum hemorrhage with misoprostol in Mozambique: final report. Maputo: Venture Strategies Innovations; 2011. Bique C, Prata N, Holston M, Moran M, Weinrib R. Community-based prevention of postpartum hemorrhage with misoprostol in Mozambique: final report. Maputo: Venture Strategies Innovations; 2011.
27.
go back to reference Chilundo B, Cliff J, Mariano A, Rodriguez D, George A. Relaunch of the official community health worker programme in Mozambique: is there a sustainable basis for iCCM policy. Health Policy Plan. 2015;30:ii54–64.CrossRef Chilundo B, Cliff J, Mariano A, Rodriguez D, George A. Relaunch of the official community health worker programme in Mozambique: is there a sustainable basis for iCCM policy. Health Policy Plan. 2015;30:ii54–64.CrossRef
28.
go back to reference Mc William CL. Phenomonology. In: Bourgeault I, Dingwall R, de Vries R, editors. The SAGE handbook of qualitative methods in health research edn. London: SAGE; 2010. p. 229–48. Mc William CL. Phenomonology. In: Bourgeault I, Dingwall R, de Vries R, editors. The SAGE handbook of qualitative methods in health research edn. London: SAGE; 2010. p. 229–48.
29.
go back to reference Ezzy D. Qualitative analysis: practice and innovation. London: Routledge; 2002. Ezzy D. Qualitative analysis: practice and innovation. London: Routledge; 2002.
30.
go back to reference Pope C, Ziebland S, Mays N. Qualitative research in health care: analysing qualitative data. Br Med J. 2000;320(7227):114–6.CrossRef Pope C, Ziebland S, Mays N. Qualitative research in health care: analysing qualitative data. Br Med J. 2000;320(7227):114–6.CrossRef
31.
go back to reference Orobaton N, Abdulazeez J, Abegunde D, Shoretire K, Maishanu A, Ikoro N, Fapohunda B, Balami W, Beal K, Ganiyu A, et al. Implementing at-scale, community-based distribution of misoprostol tablets to mothers in the third stage of labor for the prevention of postpartum haemorrhage in Sokoto state, Nigeria: early results and lessons learned. PLoS One. 2017;12(2):e0170739.CrossRef Orobaton N, Abdulazeez J, Abegunde D, Shoretire K, Maishanu A, Ikoro N, Fapohunda B, Balami W, Beal K, Ganiyu A, et al. Implementing at-scale, community-based distribution of misoprostol tablets to mothers in the third stage of labor for the prevention of postpartum haemorrhage in Sokoto state, Nigeria: early results and lessons learned. PLoS One. 2017;12(2):e0170739.CrossRef
32.
go back to reference Ejembi CL, Norick P, Starrs A, Thapa K. New global guidance supports community and lay health workers in postpartum hemorrhage prevention. Int J Gynaecol Obstet. 2013;122(3):187–9.CrossRef Ejembi CL, Norick P, Starrs A, Thapa K. New global guidance supports community and lay health workers in postpartum hemorrhage prevention. Int J Gynaecol Obstet. 2013;122(3):187–9.CrossRef
33.
go back to reference Mir AM, Wajid A, Gull S. Helping rural women in Pakistan to prevent postpartum hemorrhage: a quasi experimental study. BMC Pregnancy Childbirth. 2012;12:120.CrossRef Mir AM, Wajid A, Gull S. Helping rural women in Pakistan to prevent postpartum hemorrhage: a quasi experimental study. BMC Pregnancy Childbirth. 2012;12:120.CrossRef
34.
go back to reference Geller SE, Adams MG, Kelly PJ, Kodkany BS, Derman RJ. Postpartum hemorrhage in resource-poor settings. Int J Gynaecol Obstet. 2006;92(3):202–11.CrossRef Geller SE, Adams MG, Kelly PJ, Kodkany BS, Derman RJ. Postpartum hemorrhage in resource-poor settings. Int J Gynaecol Obstet. 2006;92(3):202–11.CrossRef
35.
go back to reference Byrne A, Morgan A. How the integration of traditional birth attendants with formal health systems can increase skilled birth attendance. Int J Gynecol Obstet. 2011;115(2):127–34.CrossRef Byrne A, Morgan A. How the integration of traditional birth attendants with formal health systems can increase skilled birth attendance. Int J Gynecol Obstet. 2011;115(2):127–34.CrossRef
36.
go back to reference Raams TM, Browne JL, Festen-Schrier VJMM, Klipstein-Grobusch K, Rijken MJ. Task shifting in active management of the third stage of labor: a systematic review. BMC Pregnancy Childbirth. 2018;18(1):47.CrossRef Raams TM, Browne JL, Festen-Schrier VJMM, Klipstein-Grobusch K, Rijken MJ. Task shifting in active management of the third stage of labor: a systematic review. BMC Pregnancy Childbirth. 2018;18(1):47.CrossRef
37.
go back to reference Kumbani L, Bjune G, Chirwa E, Malata A, Odland JØ. Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural southern Malawi. Reprod Health. 2013;10:9–9.CrossRef Kumbani L, Bjune G, Chirwa E, Malata A, Odland JØ. Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural southern Malawi. Reprod Health. 2013;10:9–9.CrossRef
39.
go back to reference Firoz T, Vidler M, Makanga PT, Boene H, Chiaú R, Sevene E, Magee LA, von Dadelszen P, Munguambe K, the CLIP Working Group. Community perspectives on the determinants of maternal health in rural southern Mozambique: a qualitative study. Reprod Health. 2016;13(Suppl 2):112.CrossRef Firoz T, Vidler M, Makanga PT, Boene H, Chiaú R, Sevene E, Magee LA, von Dadelszen P, Munguambe K, the CLIP Working Group. Community perspectives on the determinants of maternal health in rural southern Mozambique: a qualitative study. Reprod Health. 2016;13(Suppl 2):112.CrossRef
Metadata
Title
“My job is to get pregnant women to the hospital”: a qualitative study of the role of traditional birth attendants in the distribution of misoprostol to prevent post-partum haemorrhage in two provinces in Mozambique
Publication date
01-12-2018
Published in
Reproductive Health / Issue 1/2018
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-018-0622-4

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