{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T02:21:04Z","timestamp":1782526864051,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,11,28]],"date-time":"2013-11-28T00:00:00Z","timestamp":1385596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To report on a rigorous distribution and monitoring plan to track misoprostol for community\u2010based distribution to reduce postpartum haemorrhage (<jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>) in rural <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>hana.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Operations research.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Rural <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>hana.<\/jats:p><\/jats:sec><jats:sec><jats:title>Sample<\/jats:title><jats:p>Women in third trimester of pregnancy presenting to primary health centres (<jats:styled-content style=\"fixed-case\">PHC<\/jats:styled-content>s) for antenatal care (<jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ghana Health Service (<jats:styled-content style=\"fixed-case\">GHS<\/jats:styled-content>), <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>illennium <jats:styled-content style=\"fixed-case\">V<\/jats:styled-content>illage Projects, and the <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>niversity of <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content>llinois at <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>hicago conducted an operations research study designed to assess the safety, feasibility, and acceptability of community\u2010based distribution of misoprostol to prevent <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> at home deliveries in rural <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>hana. One thousand doses (3000 tablets, 200\u00a0\u03bcg each) were obtained from the Family Health Division of <jats:styled-content style=\"fixed-case\">GHS<\/jats:styled-content>. Three 200\u2010\u03bcg tablets of misoprostol (600\u00a0\u03bcg) in foil packets were packaged together in secured transparent plastic packets labelled with pictorial messages and distributed to midwives at seven <jats:styled-content style=\"fixed-case\">PHC<\/jats:styled-content>s for distribution to pregnant women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Correct use of misoprostol in home deliveries and retrieval of unused misoprostol doses, <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> rates and maternal mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 999 doses distributed to midwives, 982 (98.3%) were successfully tracked, with a 1.7% lost to follow\u2010up rate. Midwives distributed 654 doses to women at third\u2010trimester <jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content> visits. Of women who had misoprostol to use at home, 81% had an institutional delivery and were able to return the misoprostol safely to the midwife. Of the women that used misoprostol, 99% used the misoprostol correctly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study clearly demonstrates that misoprostol distributed antenatally to pregnant women can be used accurately and reliably by rural <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>hanaian women, and should be considered for policy implementation across <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>hana and other countries with high home birth rates and maternal mortality ratios.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12447","type":"journal-article","created":{"date-parts":[[2013,11,28]],"date-time":"2013-11-28T05:50:44Z","timestamp":1385617844000},"page":"319-326","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Community\u2010based distribution of misoprostol to prevent postpartum haemorrhage at home births: results from operations research in rural <scp>G<\/scp>hana"],"prefix":"10.1111","volume":"121","author":[{"given":"S","family":"Geller","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Illinois at Chicago Chicago IL USA"},{"name":"Center for Research on Women and Gender University of Illinois at Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Carnahan","sequence":"additional","affiliation":[{"name":"Center for Research on Women and Gender University of Illinois at Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Akosah","sequence":"additional","affiliation":[{"name":"Millennium Villages Project Bonsaaso Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Asare","sequence":"additional","affiliation":[{"name":"Ghana Health Service Accra 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