Smith Helen J, Colvin Christopher J, Richards Esther, Roberson Jeffrey, Sharma Geeta, Thapa Kusum, Gülmezoglu A Metin
School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK,
Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa.
Health Policy Plan. 2016 Feb;31(1):102-13. doi: 10.1093/heapol/czv012. Epub 2015 Mar 21.
Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synthesizes current knowledge about the barriers and facilitators affecting implementation of advance community distribution of misoprostol to prevent PPH, where misoprostol may be self-administered or administered by an LHW.We searched for and summarized available empirical evidence, and collected primary data from programme stakeholders about their experiences of programme implementation.We present key outcomes and features of advanced distribution programmes that are in operation or have been piloted globally. We categorized factors influencing implementation into those that operate at the health system level, factors related to the community and policy context and those factors more closely connected to the end user.Debates around advance distribution have centred on the potential risks and benefits of making misoprostol available to pregnant women and community members during pregnancy for administration in the home. However, the risks of advance distribution appear manageable and the benefits of self-administration, especially for women who have little chance of expert care for PPH, are considerable.
近期在低收入国家预防产后出血（PPH）的努力主要集中在让在家分娩的妇女能够获取口服米索前列醇。世界卫生组织建议，在没有熟练接生员的情况下，由非专业卫生工作者（LHWs）来发放米索前列醇。本综述综合了当前关于影响米索前列醇提前社区分发以预防产后出血实施的障碍和促进因素的知识，在这种情况下米索前列醇可由妇女自行服用或由非专业卫生工作者发放。我们搜索并总结了现有的实证证据，并从项目利益相关者那里收集了关于他们项目实施经验的原始数据。我们展示了全球正在运行或已试点的提前分发项目的关键成果和特点。我们将影响实施的因素分为在卫生系统层面起作用的因素、与社区和政策背景相关的因素以及那些与最终用户联系更紧密的因素。围绕提前分发的争论集中在孕期向孕妇和社区成员提供米索前列醇以便在家中服用的潜在风险和益处上。然而，提前分发的风险似乎是可控的，自行服用的益处，特别是对于几乎没有机会获得产后出血专家护理的妇女来说，是相当大的。
