Table 2 Safety and acceptance of task shifting intervention in included studies (n = 12)

Diadhiou et al., 2011 [37]

Quasi-exp. trial

health center/post and maternity huts in 2 districts, Senegal

Age: 26.4 ± 5.5

Parity:

2.9 ± 2.2

No education: 43%

6 days course including 5 days on EoC and 1 day on misoprostol administration^c

Misoprostol

auxiliary midwives

16.1% (41/255) in Thies, 4.2% (9/214) in Kaolack, both percentages refer to distribution in maternity huts

Correct dose and timing: 100% (245/245) in HC/HP and MH

Recommended to friends: n/a

Use at next delivery: n/a

Willing to pay:

85.6% (160/187) in HC, 100% (8/8) in HP, 100% (50/50) in MH

Ejembi et al., 2014 [30]

Quasi- exp. trial

5 communities North-West Nigeria

Age, parity, education: n/a

TBAs: 6 days course on home-based EoC and misoprostol administration. Women: educated on misoprostol use at home visits of TBAs.

Misoprostol, distribution by drug keeper to TBA, self-administration, friend/relative, doctor/midwife

80.2% (1265/1577), total group

- TBA:88.1% (919/1043)

- Self-administered: 66.3% (106/160)

- Friend: 67.1% (147/219) - Midwife:46.1% (47/102)

- Attendant unknown for 53 deliveries

- Total group: dose 93.2% (1179/1265), time 87.3% (1104/1265)

- TBA: dose 96.2% (884/919), time 88.9% (817/919) - Self-administered: dose 96.2% (102/106), time 77.4% (82/106) - Friend: dose 95.9% (141/147), time 85% (125/147) - Midwife: dose 93.6% (44/47), time 78.7% (37/47)

Recommended to friends: 99.7% (1260/1264)

Use at next delivery: 99.4% (1256/1264)

Willing to pay: 99.1% (1253/1264)

Post-delivery data for this topic is missing for n = 1 delivery

Geller et al., 2014 [22]

Quasi- exp. trial

30 communities in rural Ghana

Age: 24.4 ± 6.56 Parity: 2.5 ± 2.05

Education: n/a

Training of midwives and CHWs on misoprostol administration. Use of pictorial charts for women.

Misoprostol, self-administered

65% (654/999) of misoprostol tablets distributed by midwives at antenatal care visits. N = 105 (96 at home, 9 institutional) women take misoprostol

Correct dose: n/a

Correct timing: 98.9% (92/93)

No data collected for institutional deliveries

Recommended to friends:

98.6% (71/72)

Use at next delivery: 98.6% (71/72)

Willing to pay: n/a

Post-delivery data for this topic is missing for n = 21 deliveries

Mir et al.,2012 [31]

Quasi-exp trial

Dadu and Khanewal districts, India

Age 28 ± 5.7

Parity: n/a

No education: 73%

Creating of community awareness & family education regarding use of misoprostol. 1 month before delivery women were assessed retention of knowledge. 15 days before delivery again briefed on information

Misoprostol, self- administered

88% (678/770) of women that delivered at home took misoprostol

Correct dose and timing: 95% (647/678)

Recommended to friends: 80% (616/770)

Use at next delivery: 80% (616/770)

Willing to pay: 74% (570/770)

Prata et al., 2012a [33]

Quasi-exp trial

5 rural communities North-West Nigeria.

Age, parity, education: n/a

TBAs were trained to counsel pregnant women about bleeding after delivery, the importance of delivery at a health facility, and the role of misoprostol and its administration.

Misoprostol, TBA or self-administration

79% (1421/1800) of women that were interviewed postpartum took misoprostol

Correct dose: 98% (1393/1421)

Correct time: 88% (1250/1421)

Recommendations, use at next delivery, willing to pay: n/a

Prata et al., 2012b [38]

Quasi-exp trial

6 rural districts in Bangladesh

Age, parity, education: n/a

Training concerning various aspects of misoprostol and the usage of a delivery mat to measure blood loss.

Misoprostol, RDRS trained and non-RDRS TBAs, self- administration, relative, nurse/doctor

RDRS-trained TBA: 81.3% (1041/1280)

Non-RDRS TBA: 69.9% (533/762)

Relative 64.8% (250/386)

Alone 67.7% (44/65)

Doctor 7.6% (18/236)

Nurse 67.7% (44/65)

Correct dose: n/a

-TBA (trained/untrained): time 99.9% (1572/1574) - other groups: time 99.7% (355/356)

Recommended to friends: 98.6% (1903/1930)

Use at next delivery: n/a

Willing to pay: 84.6% (1633/1930)

All women that were offered misoprostol, independent of birth attendant

Prata et al., 2014 [12]

Quasi-exp. trial

6 rural districts of Rangpur Division, Bangladesh

Age (15–29): 89.3%

No education: 63% Gravidity (2+): 67.6%

RDRS trained TBAs received 2 days training on administration of misoprostol.

Misoprostol, RDRS trained TBA, non-RDRS TBA, lay person

67.4% (64.413/66489)

RDRS trained TBA: 71% non-RDRS TBA 48% lay person 54%

Correct dose: n/a

Correct time: n/a

Recommendations, use at next delivery, willing to pay: n/a

Rajbhandariet al., 2010 [39]

Quasi-exp. trial

30 clusters in 1 district in India, rural area.

Age: 25 yrs. Mean parity: 3; literate respondents: average 33%

Prenatal health education by female community health volunteers at home visits in 3–4 sessions. Other family members were involved. Advice on seeking prenatal care, planning institutional delivery, misoprostol, timely response to danger symptoms.

Misoprostol, self-administered

In study period (2006–2008) 74.5% (13969/18761) women took misoprostol. At end line of study 74% (604/816) of vaginal deliveries received misoprostol. 74% (447/604) of these women took misoprostol.

Correct dose: 98.2%(439/447)

Correct time: 100% (447/447)

Recommendations, use at next delivery, willing to pay: n/a

Sanghvi et al., 2010 [10]

Quasi-exp. trial

8 districts in Afghanistan

Age: n/a

Gravida > 1: 84.4% Education: n/a

Instructed by CHWs and SBAs during three home visits. Only received misoprostol when women were able to demonstrate understanding of the usage and risks.

Misoprostol, self-administered

99% (2021/2039) of pregnant women were offered misoprostol, 97.5% (1970/2021) accepted the drug. 70% (1421/2039) of all pregnant women, took the drug.

Correct dose: 99.8% (1418/1421)

Correct time: 95.8% (1361/1421)

Recommended to friends: 92% (1876/2039)

Use at next delivery: n/a

Willing to pay: 88% (1794/2039)

Sibley et al., 2014 [5]

Quasi-exp. trial

3 districts in Amhara and Oromiya regions of Ethiopia

Age 20-34 yrs.: 76.5%

No education: 71.9%

Parity 2–4: 51%

Facility based Community Maternal and Neonatal Health Extension Program - training, no further specification.

Misoprostol, health extension workers, CHWs, TBAs and self-administered

58.9% (600/1019) of women received misoprostol. 97.5% (585/600) used it.

Correct dose and timing: 70.7% (412/585)

Correct dose: 83.4% (483/585)

Correct time: 84.1% (491/585)

Recommendations, use at next delivery, willing to pay: n/a

Smith et al., 2014a [13]

Quasi-exp. trial

2 districts in Grand Bassa county, Liberia

Age, parity, education: n/a

Explanation of misoprostol use to women at antenatal care visits or at home visits by district reproductive health supervisor.

Misoprostol, self-administered

53.7% (980/1826) of all women received misoprostol. Of a sample of 550 women who received misoprostol 302 delivered at home, 87.7% (265/302) of them took the drug.

Correct dose: n/a

Correct time: 63% (167/265)

Recommended to friends: 99.6% (258/259)

Use at next delivery: 98.1% (254/259)

Willing to pay: 54.6% (142/260)

For some questionnaires data were missing.

Data shown are independent of distributor of misoprostol

Smith et al., 2014b [40]

Quasi-exp. trial

Mundri East County and South Sudan, Sudan

Age, parity, education: n/a

Education of misoprostol use to women at pre-natal care visits or home visits by SBAs and maternal health workers

Misoprostol, self-administered

84.9% (787/927) of women received misoprostol during pregnancy. 98.9% (527/533) of women delivering at home received misoprostol. Postpartum data were gathered for 76.1% (599/787) of women of whom 81% (485/599) had home delivery with misoprostol.

Correct dose: n/a

Correct time: 98.6% (478/485)

Recommended to friends: 95.1% (461/485)

Use at next delivery: 99.0% (480/485)

Willing to pay: 99.0% (480/485)