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KNOWLEDGE AND USE OF MISOPROSTOL IN THE PREVENTION AND TREATMENT OF POST PARTUM HAEMORRHAGE AMONG PRIMARY HEALTH CARE WORKERS IN ZARIA METROPOLIS, KADUNA STATE,NIGERIA

NURSING SCIENCE PROJECT TOPICS AND MATERIALS

ABSTRACT

Postpartum haemorrhage (PPH) is the common cause of obstetric haemorrhage and the leading cause of maternal deaths in Nigeria. Injectable uterotonics, which include ergometrine, oxytocin and syntometrine are the conventional drugs used and also remain the first line drug for prevention and treatment of PPH. However, these drugs are heat-sensitive when exposed to hot climates over long period of time which means they need to be refrigerated in order to maintain their potency. This may be difficult in low-resource settings or rural areas where electricity is very erratic.Misoprostol, another uterotonic that is available in tablet form, was thus approved by the Federal Ministry of Health. The purpose of this study was determine the knowledge and use of misoprostol in the prevention and treatment of Post-Partum haemorrhage. The research design was a descriptive survey method nd one hundred and fifty six primary health care workers that met the inclusion criteria across the twenty five facilities of Sabon Gari and Zaria local government area were included for the study. A validated questionnaire constructed by the researcher based on the guidelines on the use of misoprostol in the prevention an d treatment of Post-Partum haemorrhage was used for data collection. Information derived from the questionnaire was subjected to descriptive statistics and chi-square test of association. The findings from the study showed that only 31.3% of the respondents had high level of knowledge   of misoprostol in the prevention and treatment of PPH and only 38.3% of the respondents had used misoprostol correctly for the prevention of PPH .For the treatment of   PPH, findings revealed that  only 16.3% of the respondents had used misoprostol correctly. Only about a quarter of the respondents (23.3%) had received training on the use of misoprostol and (27.3%) of the respondents claimed that the drug was always available in their facility. Knowledge of misoprostol was associated with the correct use of misoprostol for the prevention and treatment of PPH. Based on the findings the following recommendations were made; investment in training and retraining of primary health care workers on the use of misoprostol in the prevention and treatment of post-partum haemorrhage, monitoring and supervision of primary health care workers on the use of the drug and frequent supply and sustainable commodity management will be  good mechanisms to improve availability of the drug and thus promote  the frequent use of the drug.

 

CHAPTER ONE

INTRODUCTION

Background to the Study

Maternal mortality has been and still continues to be a public health problem particularly in developing countries. It is made more tragic because women die in the process of performing the essential physiologic function of childbearing and in efforts to fulfill their natural role of perpetuating the human race. According to WHO (2005), maternal mortality is the death of a woman while pregnant or within 42 days of termination of a pregnancy irrespective of the duration or site of the pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental causes. Globally, an estimated 287 000 maternal deaths occurred in 2010, Sub-Saharan Africa (56%) and Southern Asia (29%) accounted for 85% of the global burden (245 000 maternal deaths) in 2010. At the country level, two countries account for a third of global maternal deaths: India at 19% (56 000) and Nigeria at 14% (40,000) (WHO,UNFPA, UNICEF & World Bank, 2012).

In Nigeria, the maternal mortality is estimated to be 545/100,000 live births (National Demography & Health Survey 2008). Indeed, the country has been ranked as the number two country (after India) with the highest absolute number of maternal death in the world. The causes of maternal mortality were reported in percentages as post partum haemorrhage (23%), infections (13%), unsafe abortion (13%), eclampsia (12%),obstructed labour (8%), other direct causes (8%) and indirect causes 20% (FMOH, 2007). Indirect causes such as malaria, anaemia, HIV/AIDS and cardiovascular disease complicate pregnancy or are aggravated by it (WHO, 2005).

Postpartum hemorrhage (PPH) is the common cause of obstetric haemorrhage and the leading cause of maternal death in Nigeria, as one in four maternal deaths is due to it (FMOH, 2007).According to the World Health Organization (WHO, 2000), PPH is defined as bleeding from the genital tract of 500 ml or more within the first 24 hours of delivery of the baby. Bleeding after delivery is normal; however excessive bleeding is often fatal. Uterine atony, which is the failure of the uterus to properly contract after delivery, is the commonest cause, accounting for about 90% cases of PPH (Chelmow, 2008). Other causes of PPH include tear in the cervix or vaginal tissue, uterine rupture, retained placenta or membrane, blood clotting disorders such as disseminated intravascular coagulation accounting for 10% of cases (FMOH, 2007).

 

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