Stakeholder analysis of community distribution of misoprostol in Lao PDR: a qualitative study

Durham, Jo, Warner, Melissa, Phengsavanh, Alongkone, Sychareun, Vanphanom, Vongxay, Viengnakhone and Rickart, Keith (2016) Stakeholder analysis of community distribution of misoprostol in Lao PDR: a qualitative study. PLoS One, 11 9: e0162154. doi:10.1371/journal.pone.0162154


Author Durham, Jo
Warner, Melissa
Phengsavanh, Alongkone
Sychareun, Vanphanom
Vongxay, Viengnakhone
Rickart, Keith
Title Stakeholder analysis of community distribution of misoprostol in Lao PDR: a qualitative study
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2016-09-15
Year available 2016
Sub-type Article (original research)
DOI 10.1371/journal.pone.0162154
Open Access Status DOI
Volume 11
Issue 9
Start page e0162154
Total pages 17
Place of publication San Francisco, United States
Publisher Public Library of Science
Language eng
Abstract Globally, significant progress has been made in reducing maternal mortality, yet in many low-resource contexts it remains unacceptably high. Many of these deaths are due to postpartum haemorrhage and are preventable with access to essential obstetric care. Where there are barriers to access, maternal deaths could be prevented if community-level misoprostol was available. The purpose of this study was to explore perceptions of stakeholders regarding misoprostol use in the Lao People's Democratic Republic, a setting with high maternal mortality.

Semi-structured interviews were conducted with 35 stakeholders in the capital, Vientiane and in one northern province identified as a site for a possible intervention. The sample included international and national stakeholders involved in policy-making and providing maternal and reproductive health services.

Most stakeholders supported a pilot program for community distribution of misoprostol but levels of awareness of the drug's use in preventing postpartum haemorrhage and level of influence over policy direction varied considerably. Some international organizations, all identified as powerful in influencing policy, were ambivalent about the use of community distribution of misoprostol. Concerns related to the capacity of village health workers or lay people to safely administer misoprostol, whether its distribution would undermine efforts to improve access to safe delivery services and active management of the third stage of labour, the ease with which prescription drugs can be bought over the counter, and technical, logistical, and financial constraints.

Access to appropriate oxytocic drugs is a matter of health equity. In settings without access to essential obstetrical care, misoprostol represents a viable solution for the prevention of postpartum haemorrhage. Understanding stakeholders' perspectives and their legitimate concerns on misoprostol can inform interventions in order to assuage these concerns and enable disadvantaged women to access misoprostol and its potentially life-saving benefits.
Formatted abstract
Background

Globally, significant progress has been made in reducing maternal mortality, yet in many low-resource contexts it remains unacceptably high. Many of these deaths are due to postpartum haemorrhage and are preventable with access to essential obstetric care. Where there are barriers to access, maternal deaths could be prevented if community-level misoprostol was available. The purpose of this study was to explore perceptions of stakeholders regarding misoprostol use in the Lao People’s Democratic Republic, a setting with high maternal mortality.

Methods

Semi-structured interviews were conducted with 35 stakeholders in the capital, Vientiane and in one northern province identified as a site for a possible intervention. The sample included international and national stakeholders involved in policy-making and providing maternal and reproductive health services.

Findings

Most stakeholders supported a pilot program for community distribution of misoprostol but levels of awareness of the drug’s use in preventing postpartum haemorrhage and level of influence over policy direction varied considerably. Some international organizations, all identified as powerful in influencing policy, were ambivalent about the use of community distribution of misoprostol. Concerns related to the capacity of village health workers or lay people to safely administer misoprostol, whether its distribution would undermine efforts to improve access to safe delivery services and active management of the third stage of labour, the ease with which prescription drugs can be bought over the counter, and technical, logistical, and financial constraints.

Conclusion

Access to appropriate oxytocic drugs is a matter of health equity. In settings without access to essential obstetrical care, misoprostol represents a viable solution for the prevention of postpartum haemorrhage. Understanding stakeholders’ perspectives and their legitimate concerns on misoprostol can inform interventions in order to assuage these concerns and enable disadvantaged women to access misoprostol and its potentially life-saving benefits.
Keyword Multidisciplinary Sciences
Science & Technology - Other Topics
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Article number e0162154

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Public Health Publications
 
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Created: Sun, 18 Sep 2016, 12:30:47 EST by Jo Durham on behalf of School of Public Health