Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention

BMC Pregnancy and Childbirth

Md Abdul Quaiyum²  Suzanne Bell³  Ndola Prata¹ 

[1] Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, 229 University Hall, UC Berkeley, Berkeley, CA 94720-7360, USA;icddr,b, Centre for Reproductive Health, GPO Box 128, Dhaka 1000, Bangladesh;Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, 17 University Hall, UC Berkeley, Berkeley, CA 94720-7360, USA

关键词: Monte Carlo;    Delivery mat;    Misoprostol;    Maternal mortality;    Postpartum hemorrhage;    Bangladesh;    Traditional birth attendant;   

Others  :  1127559
DOI  :  10.1186/1471-2393-14-78

 received in 2013-08-02, accepted in 2014-02-05,  发布年份 2014

【 摘 要 】

Background

Bangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh.

Methods

Using data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions.

Results

Using project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births.

Conclusion

This theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further reduce maternal mortality at home births.

【 授权许可】

   
2014 Prata et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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