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

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 to determine the knowledge and use of misoprostol in the prevention and treatment of Post-Partum haemorrhage. The research design was a descriptive survey method and 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.

TABLE OF CONTENTS

Title page - - - - - - - - - i

Certification - - - - - - - - - ii

Declaration - - - - - - - - - iii

Dedication - - - - - - - - - iv

Acknowledgement - - - - - - - - v

Table of contents - - - - - - - - vi

List of tables - - - - - - - - - ix

List of figures- - - - - - - - - x

List of Appendices - - - - - - - - xi

Abstract - - - - - - - - - xii

Chapter One: Introduction - - - - - - - 1

Background to the Study - - - - - - - 1

Statement of Problem - - - - - - - 4

Purpose of the Study - - - - - - - 5

Objectives of the Study - - - - - - - 5

Research Questions - - - - - - - 5

Significance of the Study - - - - - - - 6

Scope of the Study - - - - - - - 6

Operational Definition of Terms - - - - - - 7

Chapter Two: Literature Review - - - - - - 9

Overview of Maternal Mortality and Post Partum Haemorrhage - - 9

Prevalence of Post Partum Haemorrhage - - - - - 12

Overview of Anatomy and Physiology of the Uterus - - - 14

Uterine and Cervical Coats - - - - - - - 15

Uterine Blood Supply - - - - - - - 16

Pathophysiology of Post-Partum Haemorrhage - - - - 18

Causes and Risk factor of Post Partum Haemorrhage - - - 18

Management of Post-Partum haemorrhage - - - - - 19

Misoprostol in the Prevention and Treatment of Post Partum Haemorrhage 20

Advantages of misoprostol over other conventional uterotonic drug in

prevention and management of post-partum haemorrhage - - - 21

Steps in Misoprostol Administration for the prevention of postpartum haemorrhage - - - - - - - - - - 22

Side effects of misoprostol in the prevention and management of PPH - 23

Health workers responsibility in administration of misoprostol

in prevention and treatment of PPH - - - - - - 23

Factors influencing Use and Non – Use of this drug - - - 23

Theoretical Review - - - - - - - - 24

Empirical Review - - - - - - - - 33

Summary - - - - - - - - - 39

Chapter Three: Research Methods- - - - - - 41

Research Design - - - - - - - - 41

Area of the Study - - - - - - - - 41

Population of study - - - - - - - 42

Subjects of Study - - - - - - - - 42

Instrument for data collection - - - - - - - 43

Validity of the research instruments - - - - - - 43

Reliability of the research instrument - - - - - - 43

Ethical Consideration - - - - - - - 44

Procedure for data collection - - - - - - - 44

Method of data analysis - - - - - - - 45

Chapter four: Presentation Of Results

Presentation of data - - - - - - - - 46

Summary of major findings - - - - - - - 58

Chapter five: Discussion Of Findings

Discussion of findings - - - - - - - 59

Implication for Nursing - - - - - - - 62

Limitations of the Study - - - - - - - 63

Suggestion for further studies - - - - - - 63

Summary - - - - - - - - - 64

Conclusion - - - - - - - - - 65

Recommendations - - - - - - - - 66

References - - - - - - - 67

Appendices - - - - - - - 70

Questionnaire- - - - - - - - Appendices A

Distribution of Respondents- - - - - - - Appendices B

Reliability- - - - - - - - - Appendices C

Ethical Clearance- - - - - - - - Appendices D

Letter of permission to carry out research- - - - - Appendices E

Letter of introduction-- - - - - - - Appendices F

Inform consent sheet- - - - - - - - Appendices G