Журнал женского здоровья
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“Please Do Not Forget Us” - Views of Women, Nurses, and Traditional Birth Attendants on Community Distribution of Medications to Prevent Postpartum Hemorrhage and Sepsis: A Qualitative Pilot Study in Rural Tanzania

Gail Webber and Bwire Chirangi

Background: Postpartum hemorrhage and sepsis are the most common causes of death for women in childbirth globally. In rural Tanzania where about one woman dies every hour from childbirth, over sixty percent of women deliveroutside of health care institutions and therefore lack access to medications to prevent bleeding and infection. In thisstudy, women delivering in rural Rorya District in northern Tanzania were provided with 600 micrograms of misoprostoland 500 mg of erythromycin to take immediately after delivery to prevent postpartum hemorrhage and sepsis. Thepurpose of the study was to assess the feasibility of distributing these medications. Methods: Selected women, dispensary nurses and traditional birth attendants who were involved in deliveries where the two study medications were taken were interviewed by research assistants in the local language of Kiswahiliabout their views on community distribution of these two medications. The interviews were taped with digital recordersand the recordings were transcribed and translated into English. The English transcripts were independently coded bytwo researchers using a qualitative software analysis program, assessing for common and diverging themes betweenand within the three groups of interviewees. Results: A total of 32 women, 17 dispensary nurses, and 13 traditional birth attendants were interviewed. Therewas strong support for community distribution of medications to prevent bleeding and infection after delivery amongst the participants. Other common themes from the research included family involvement in the decision of the women to take the medications, safe storage of the medications by the women, and minimal side effects of the medications.A variety of people administered the medications. Several participants observed that provision of the medications by dispensary nurses improved women’s access to the dispensaries. Views differed on whether traditional birth attendants should be permitted to distribute the medications. Conclusions: There is strong support from rural women, dispensary nurses, and traditional birth attendants fora community distribution program of medications to prevent postpartum hemorrhage and sepsis. Future research willfocus on the distribution of misoprostol in clean delivery kits directly to rural women by local health providers, as thereis insufficient evidence for prevention of sepsis by inclusion of a single dose of antibiotics.