TY - JOUR
T1 - The effects of a peripartum strategy to prevent and treat primary postpartum haemorrhage at health facilities in Niger
T2 - a longitudinal, 72-month study
AU - Seim, Anders R.
AU - Alassoum, Zeidou
AU - Souley, Ibrahim
AU - Bronzan, Rachel
AU - Mounkaila, Aida
AU - Ahmed, Luai A.
N1 - Funding Information:
Funding from the governments of Norway (grant QZA-0325 NER 13/0003) and Niger, together with the Kavli Trust (Kavlifondet), the InFiL Foundation, and individuals in Norway, the UK, and the USA has made this work possible. Sincere thanks to André Lalonde for help during initial discussions with the Government of Niger and training, to Suellen Miller, Elizabeth Butrick, and the Bixby Center for Global Reproductive Health at the University of California, San Francisco, USA, for help in starting the initiative and initial training, to Suellen Miller for permission to use the non-inflatable anti-shock garment illustrations, to Ramatou Also Alio for her years of dedicated help with data and field activities in the Health and Development International office, to Oumoulkair Hamidou for excellently taking over those activities, to Moni Blazej Neradilek for statistical support in designing and analysing the preintervention survey, to Yaroh Asma Gali for inspiring discussions, her personal commitment, and her leadership, and to Tore Godal, then in the Norway Ministry of Foreign Affairs, for his decision to provide initial funding for this ambitious effort. Most importantly, we extend our sincere appreciation and deep admiration to the thousands of health professionals across Niger, and to the women of Niger and their family members; it is in fact their achievements we have the honour to be reporting here.
Funding Information:
Funding from the governments of Norway (grant QZA-0325 NER 13/0003) and Niger, together with the Kavli Trust (Kavlifondet), the InFiL Foundation, and individuals in Norway, the UK, and the USA has made this work possible. Sincere thanks to André Lalonde for help during initial discussions with the Government of Niger and training, to Suellen Miller, Elizabeth Butrick, and the Bixby Center for Global Reproductive Health at the University of California, San Francisco, USA, for help in starting the initiative and initial training, to Suellen Miller for permission to use the non-inflatable anti-shock garment illustrations, to Ramatou Also Alio for her years of dedicated help with data and field activities in the Health and Development International office, to Oumoulkair Hamidou for excellently taking over those activities, to Moni Blazej Neradilek for statistical support in designing and analysing the preintervention survey, to Yaroh Asma Gali for inspiring discussions, her personal commitment, and her leadership, and to Tore Godal, then in the Norway Ministry of Foreign Affairs, for his decision to provide initial funding for this ambitious effort. Most importantly, we extend our sincere appreciation and deep admiration to the thousands of health professionals across Niger, and to the women of Niger and their family members; it is in fact their achievements we have the honour to be reporting here.
Publisher Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
PY - 2023/2
Y1 - 2023/2
N2 - Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: The Government of Norway, the Government of Niger, the Kavli Trust (Kavlifondet), the InFiL Foundation, and individuals in Norway, the UK, and the USA. Translation: For the French translation of the abstract see Supplementary Materials section.
AB - Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: The Government of Norway, the Government of Niger, the Kavli Trust (Kavlifondet), the InFiL Foundation, and individuals in Norway, the UK, and the USA. Translation: For the French translation of the abstract see Supplementary Materials section.
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U2 - 10.1016/S2214-109X(22)00518-6
DO - 10.1016/S2214-109X(22)00518-6
M3 - Article
C2 - 36669809
AN - SCOPUS:85146321826
SN - 2214-109X
VL - 11
SP - e287-e295
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 2
ER -