Health and Development International, Fjellstrand, Norway.
Health and Development International, Niamey, Niger.
Lancet Glob Health. 2023 Feb;11(2):e287-e295. doi: 10.1016/S2214-109X(22)00518-6.
Primary postpartum haemorrhage is the principal cause of birth-related maternal mortality in most settings and has remained persistently high in severely resource-constrained countries. We evaluate the impact of an intervention that aims to halve maternal mortality caused by primary postpartum haemorrhage within 2 years, nationwide in Niger.
In this 72-month longitudinal study, we analysed the effects of a primary postpartum haemorrhage intervention in hospitals and health centres in Niger, using data on maternal birth outcomes assessed and recorded by the facilities' health professionals and reported once per month at the national level. Reported data were monitored, compiled, and analysed by a non-governmental organisation collaborating with the Ministry of Health. All births in all health facilities in which births occurred, nationwide, were included, with no exclusion criteria. After a preintervention survey, brief training, and supplies distribution, Niger implemented a nationwide primary postpartum haemorrhage prevention and three-step treatment strategy using misoprostol, followed if needed by an intrauterine condom tamponade, and a non-inflatable anti-shock garment, with a specific set of organisational public health tools, aiming to reduce primary postpartum haemorrhage mortality.
Among 5 382 488 expected births, 2 254 885 (41·9%) occurred in health facilities, of which information was available on 1 380 779 births from Jan 1, 2015, to Dec 31, 2020, with reporting increasing considerably over time. Primary postpartum mortality decreased from 82 (32·16%; 95% CI 25·58-39·92) of 255 health facility maternal deaths in the 2013 preintervention survey to 146 (9·53%; 8·05-11·21) of 1532 deaths among 343 668 births in 2020. Primary postpartum haemorrhage incidence varied between 1900 (2·10%; 2·01-2·20) of 90 453 births and 4758 (1·47%; 1·43-1·52) of 322 859 births during 2015-20, an annual trend of 0·98 (95% CI 0·97-0·99; p<0·0001).
Primary postpartum haemorrhage morbidity and mortality declined rapidly nationwide. Because each treatment technology that was used has shown some efficacy when used alone, a strategic combination of these treatments can reasonably attain outcomes of this magnitude. Niger's strategy warrants testing in other low-income and perhaps some middle-income settings.
The Government of Norway, the Government of Niger, the Kavli Trust (Kavlifondet), the InFiL Foundation, and individuals in Norway, the UK, and the USA.
For the French translation of the abstract see Supplementary Materials section.
在大多数情况下，产后大出血是导致产妇死亡的主要原因，在资源严重受限的国家，这一问题一直居高不下。我们评估了一项旨在将尼日尔全国范围内因产后大出血导致的产妇死亡率在两年内减半的干预措施的效果。
在这项为期 72 个月的纵向研究中，我们分析了尼日尔医院和卫生中心开展的产后出血干预措施的效果，使用了设施内卫生专业人员评估和记录的产妇分娩结局数据，并在国家层面每月报告一次。非政府组织与卫生部合作对报告的数据进行监测、汇编和分析。全国所有有分娩发生的卫生设施都包括在内，没有排除标准。在进行了预干预调查、简短培训和供应品分发之后，尼日尔实施了一项全国性的产后出血预防和三步治疗策略，使用米索前列醇，如果需要，还可以使用宫内避孕套塞子和非充气抗休克服，并使用一套特定的组织公共卫生工具，旨在降低产后出血死亡率。
在预计的 5382488 次分娩中，有 2254885 次（41.9%）发生在卫生机构，其中有 1380779 次的信息可从 2015 年 1 月 1 日至 2020 年 12 月 31 日获得，随着时间的推移，报告数量大大增加。产后主要死亡率从 2013 年预干预调查中的 255 例卫生机构产妇死亡中的 82 例（32.16%；95%CI 25.58-39.92）下降到 2020 年 343668 例分娩中的 1532 例死亡中的 146 例（9.53%；8.05-11.21）。产后出血发病率在 2015-20 年期间，从 90453 例分娩中的 1900 例（2.10%；2.01-2.20）到 322859 例分娩中的 4758 例（1.47%；1.43-1.52）之间变化，每年呈 0.98%（95%CI 0.97-0.99；p<0.0001）的趋势下降。
全国范围内产后出血发病率和死亡率迅速下降。由于单独使用的每种治疗技术都显示出一定的疗效，因此可以合理地采用这些治疗技术的组合来实现如此规模的结果。尼日尔的策略值得在其他低收入国家，也许是一些中等收入国家进行测试。
挪威政府、尼日尔政府、Kavli 信托基金会（Kavlifondet）、InFiL 基金会以及挪威、英国和美国的个人。
