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.


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.


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 haemorrhag       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 


1.1 Background to the Study

Maternal mortality has been and still continues to be a public health problem particularly in developing countries. It is made more tragic because women die in the process of performing the essential physiologic function of childbearing and in efforts to fulfill their natural role of perpetuating the human race.

According to WHO (2005), maternal mortality is the death of a woman while pregnant or within 42 days of termination of a pregnancy irrespective of the duration or site of the pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental causes.

Globally, an estimated 287 000 maternal deaths occurred in 2010, Sub-Saharan Africa (56%) and Southern Asia (29%) accounted for 85% of the global burden (245 000 maternal deaths) in 2010.

At the country level, two countries account for a third of global maternal deaths: India at 19% (56 000) and Nigeria at 14% (40,000) (WHO,UNFPA, UNICEF & World Bank, 2012).

In Nigeria, the maternal mortality is estimated to be 545/100,000 live births (National Demography & Health Survey 2008). Indeed, the country has been ranked as the number two country (after India) with the highest absolute number of maternal death in the world.


Adewunmi, OA (1986): Maternal mortality in Ibadan West African J. Med 5:121-7.

Akiode, A and Akin, A (2008): Off label use of misoprostol among Nigeria obstetricians – gynaecologist Internal. Ipas Report.

Anya, SE (1999); Trends on maternal mortality due to haemorrhage at the Federal Medical Centre Umuahia, Nigeria. Tropical Journal of. obstetric gynaecology pg 1-5.

Balachandran, V (2005): Maternal mortality in Kaduna Nigeria. Med. Journal 22(4). Pg 360- 70.

Carolli G, Guesfa C, Abolus E, and Gulnezoglu AM (2008): Epidemiology of postpartumhaemorrhage: A systematic review. Best practice and research clinical obstetric and gynaecology 22(5):999-1012.

Centre for Reproductive Rights and women Advocate Research and documentation Centre (2006). Broken promises: Human rights, accountability and  maternal  death  in  Nigeria.

By admin

Leave a Reply

Your email address will not be published. Required fields are marked *