Community mobilization to reduce postpartum hemorrhage in home births in northern Nigeria Ndola Prata a, * , Clara Ejembi b , Ashley Fraser a , Oladapo Shittu c , Meredith Minkler d a Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, 229 University Hall, Berkeley, CA 94720-7360, USA b Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria c Department of Obstetrics and Gynecology, Ahmadu Bello University, Zaria, Nigeria d Community Health and Human Development, School of Public Health, University of California, 207 University Hall, Berkeley, CA 94720-7360, USA article info Article history: Available online 28 January 2012 Keywords: Nigeria Community mobilization Misoprostol Home birth Postpartum hemorrhage Maternal mortality Community participation Intervention Birth attendants abstract The purpose of this study is to demonstrate the importance of community mobilization in the uptake of a health intervention, namely, community-based distribution of misoprostol to prevent postpartum hemorrhage. Community mobilization to increase access to misoprostol for postpartum hemorrhage prevention was implemented in northwestern Nigeria in 2009. Theories of community participation and the current near-epidemic maternal mortality conditions underpin an approach using modest levels of community involvement. The study was undertaken in five communities around Zaria, Nigeria. Community leaders and selected community members participated in a series of dialogs. Additionally, community education, information and dramas sessions were held. Twenty nine community oriented resource persons (CORPs), 27 drug keepers and 41 traditional birth attendants (TBAs) were involved in the intervention. Postpartum interviews were used to assess the impact of community mobilization efforts and to track use of misoprostol. Multiple logistic regression was used to examine the association between correct use and receiving information regarding misoprostol from TBAs or CORPs. A total of 1875 women were enrolled in the study in 2009. Most women delivered at home (95%) and skilled attendance at delivery was low (7%). Community mobilization efforts reached most women with information about postpartum hemorrhage and misoprostol (88%), resulting in high comprehension of intervention messages. Women identified TBAs and CORPs as the single most important source of information about misoprostol 41% and 31% of the time, respectively. Availability of misoprostol at the community level gave 79% of enrolled women some protection against postpartum hemorrhage which they otherwise would not have had. Although high level community participation in health care inter- ventions is the ideal, this study suggests that even in circumstances where only modest levels of participation can realistically be achieved, community mobilization can have a significant impact on the successful distribution and uptake of a potentially life-saving health intervention, in turn helping promote policy change. Ó 2012 Elsevier Ltd. All rights reserved. Introduction More than 300,000 deaths annually are due to maternal mortality worldwide (Hogan et al., 2010). Nigeria is one of 6 countries which together account for nearly half (49%) of all maternal deaths in the world (Hogan et al., 2010). Globally, post- partum hemorrhage is the leading single direct cause of maternal mortality worldwide (Rajan & Wing, 2010) and in Nigeria, it accounts for nearly a quarter (23%) of maternal deaths (Federal Ministry of Health, 2007a,b). Poor, rural women who have home births are more vulnerable to the risks associated with postpartum hemorrhage (Ujah, Ejembi, Ezegwi, & Adedokun, 2008). In developing countries, most women deliver at home without skilled birth attendants (Prata, Sreenivas, Vahidnia, & Potts, 2009). The most effective methods for preventing postpartum hemor- rhage and the gold standard of care involve active management of the third stage of labor (AMTSL) (Begley et al., 2010), using oxytocin which requires skilled administration by injection and special storage conditions (Alfirevic, Blum, Walraven, Weeks, & Winikoff, 2007), measures that are typically not feasible in rural areas. Misoprostol, a proven uterotonic drug, offers a practical alternative for preventing postpartum hemorrhage (Alfirevic et al., 2007; * Corresponding author. E-mail address: ndola@berkeley.edu (N. Prata). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2011.11.035 Social Science & Medicine 74 (2012) 1288e1296