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Boakye G, Gyedu A, Stewart M, Donkor P, Mock C, Stewart B. Assessment of local supply chains and stock management practices for trauma care resources in Ghana: a comparative small sample cross-sectional study. BMC Health Serv Res 2021; 21:66. [PMID: 33441147 PMCID: PMC7805234 DOI: 10.1186/s12913-021-06063-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care. METHODS Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability. RESULTS There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3-57 vs 0-9 stock-outs, respectively; p = 0.05), duration of stock-outs (median 171 vs 8 days, range 51-1268 vs 0-182 days, respectively; p = 0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p = 0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2 = 0.72; p value for each covariate between 0.17-0.34). CONCLUSIONS Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals.
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Affiliation(s)
- Godfred Boakye
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Ghana Armed Forces, Accra, Ghana
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Melissa Stewart
- Foster School of Business, University of Washington, Seattle, USA
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Harborview Injury Prevention & Research Center, Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Barclay Stewart
- Harborview Injury Prevention & Research Center, Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
- Department of Surgery, Division of Trauma, Burn and Critical Care Surgery, UW Medicine, Harborview Medical Center 325 9th Ave, Box 359796, Seattle, WA 98104 USA
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Lambert P, McIntosh MP, Widmer M, Evans L, Rauscher M, Kuwana R, Theunissen F, Yeager B, Petach H. Oxytocin quality: evidence to support updated global recommendations on oxytocin for postpartum hemorrhage. J Pharm Policy Pract 2020; 13:14. [PMID: 32467764 PMCID: PMC7227300 DOI: 10.1186/s40545-020-00205-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The use of quality injectable oxytocin effectively prevents and treats postpartum hemorrhage, the leading cause of maternal death worldwide. In low- and middle-income countries (LMICs), characteristics of oxytocin-specifically its heat sensitivity-challenge efforts to ensure its quality throughout the health supply chain. In 2019, WHO, UNFPA and UNICEF released a joint-statement to clarify and recommend that oxytocin should be kept in the cold chain (between 2 and 8 °C) during transportation and storage; however, confusion among stakeholders in LMICs persists. OBJECTIVES AND METHODS To further support recommendations in the WHO/UNFPA/UNICEF joint-statement, this paper reviews results of oxytocin quality testing in LMICs, evaluates product stability considerations for its management and considers quality risks for oxytocin injection throughout the health supply chain. This paper concludes with a set of recommended actions to address the challenges in maintaining quality for a heat sensitive pharmaceutical product. RESULTS Due to the heat sensitivity of oxytocin, its quality may be degraded at numerous points along the health supply chain including: At the point of manufacture, due to poor quality active pharmaceutical ingredients; lack of sterile manufacturing environments; or low-quality manufacturing processesDuring storage and distribution, due to lack of temperature control in the supply chain, including cold chain at the end user health facilitySafeguarding the quality of oxytocin falls under the purview of national medicines regulatory authorities; however, regulators in LMICs may not adhere to good regulatory practices. CONCLUSIONS Storing oxytocin from 2 to 8 °C throughout the supply chain is important for maintaining its quality. While short temperature excursions may not harm product quality, the cumulative heat exposure is generally not tracked and leads to degradation. National and sub-national policies must prioritize procurement of quality oxytocin and require its appropriate storage and management.
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Affiliation(s)
- Peter Lambert
- Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Michelle P McIntosh
- Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Mariana Widmer
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lawrence Evans
- Promoting Quality of Medicines Plus Program, U.S. Pharmacopeial Convention, Rockville, MD USA
| | - Megan Rauscher
- Global Health Supply Chain Program-Procurement and Management Project, Chemonics International, 251 18th Street South, Suite 1200, Arlington, VA 22202 USA
| | - Rutendo Kuwana
- Regulatory Systems Support, World Health Organization, Geneva, Switzerland
| | | | - Beth Yeager
- Promoting Quality of Medicines Plus Program, U.S. Pharmacopeial Convention, Rockville, MD USA
| | - Helen Petach
- Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC USA
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Ejekam CS, Okafor IP, Anyakora C, Ozomata EA, Okunade K, Oridota SE, Nwokike J. Clinical experiences with the use of oxytocin injection by healthcare providers in a southwestern state of Nigeria: A cross-sectional study. PLoS One 2019; 14:e0208367. [PMID: 31600195 PMCID: PMC6786624 DOI: 10.1371/journal.pone.0208367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 09/15/2019] [Indexed: 12/05/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is a leading cause of maternal mortality in Nigeria and in most low- and middle-income countries. The World Health Organization (WHO) strongly recommends oxytocin as effective, affordable, and the safest drug of first choice in the prevention and treatment of PPH in the third stage of labor. However, there are concerns about its quality. Very high prevalence of poor-quality oxytocin, especially in Africa and Asia, has been reported in literature. Excessive and inappropriate use of oxytocin is also common in low-resource settings. Objective To assess clinical experiences with quality of oxytocin used by healthcare providers in Lagos State, Nigeria. Methods This was a descriptive cross-sectional study conducted in 2017, with 705 respondents (doctors and nurses) who use oxytocin for obstetrics and gynecological services recruited from 195 health facilities (public and registered private) across Lagos State. Data collection was quantitative, using a pretested self-administered questionnaire. Data analysis was performed with IBM SPSS version 21. Statistical significance was set at 5 percent (p<0.05). Ethical approval was obtained from Lagos University Teaching Hospital Health Research Ethics Committee. Results Only 52 percent of the respondents knew oxytocin should be stored at 2°C to 8°C. About 80 percent of respondents used oxytocin for augmentation of labor, 68 percent for induction of labor, 51 percent for stimulation of labor, and 78 percent for management of PPH. Forty-one percent used 20IU and as much as 10% used 30IU to 60IU for management of PPH. About 13 percent of respondents reported believing they had used an ineffective brand of oxytocin in their practice. Just over a third (36%) had an available means of documenting or reporting perceived ineffectiveness of drugs in their facility; of these, only about 12 percent had pharmacovigilance forms in their facilities to report the ineffectiveness. Conclusion The inappropriate and inconsistent use of oxytocin, especially overdosing, likely led to the high perception of medicine effectiveness among respondents. This is coupled with lack of suspicion of medicine ineffectiveness by clinicians as a possible root cause of poor treatment response or disease progression. Poor knowledge of oxytocin storage and consequent poor storage practices could have contributed to the ineffectiveness reported by some respondents. It is necessary to establish a unified protocol for oxytocin use that is strictly complied with. Continuous training of healthcare providers in medicine safety monitoring is advocated.
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Affiliation(s)
- Chioma Stella Ejekam
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ifeoma Peace Okafor
- Department of Community Health and Primary care, College of Medicine, University of Lagos, Akoka Lagos, Nigeria
| | - Chimezie Anyakora
- Promoting the Quality of Medicines Program, U.S. Pharmacopeial Convention, Rockville, Maryland, United States of America
| | - Ebenezer A Ozomata
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Kehinde Okunade
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Sofela Ezekiel Oridota
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Community Health and Primary care, College of Medicine, University of Lagos, Akoka Lagos, Nigeria
| | - Jude Nwokike
- Promoting the Quality of Medicines Program, U.S. Pharmacopeial Convention, Rockville, Maryland, United States of America
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Finlayson K, Downe S, Vogel JP, Oladapo OT. What matters to women and healthcare providers in relation to interventions for the prevention of postpartum haemorrhage: A qualitative systematic review. PLoS One 2019; 14:e0215919. [PMID: 31067245 PMCID: PMC6505942 DOI: 10.1371/journal.pone.0215919] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/10/2019] [Indexed: 12/02/2022] Open
Abstract
Background Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity. Reducing deaths from PPH is a global challenge. The voices of women and healthcare providers have been missing from the debate around best practices for PPH prevention. The aim of this review was to identify, appraise and synthesize available evidence about the views and experiences of women and healthcare providers on interventions to prevent PPH. Methods We searched eight electronic databases and reference lists of eligible studies published between 1996 and 2018, reporting qualitative data on views and experiences of PPH in general, and of any specific preventative intervention(s). Authors’ findings were extracted and synthesised using meta-ethnographic techniques. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting themes was assessed using GRADE-CERQual. A line of argument synthesis was developed. Results Thirty-five studies from 29 countries met our inclusion criteria. Our results indicate that women and healthcare providers recognise the dangers of severe blood loss in the perinatal and postpartum period, but don’t always share the same beliefs about the causes and consequences of PPH. Skilled birth attendants and traditional birth attendants (TBA’s) want to prevent PPH but may lack the required resources and training. Women generally appreciate PPH prevention strategies, especially where their individual needs, beliefs and values are taken into account. Women and healthcare providers also recognize the value of using uterotonics (medications that contract the uterus) to prevent PPH but highlight safety concerns and potential misuse of the drugs as acceptability and implementation issues. Conclusions Based on stakeholder views and experiences, PPH prevention strategies are more likely to be successful where all stakeholders agree on the causes and consequences of severe postpartum blood loss, especially in the context of sufficient resources and effective implementation by competent, suitably trained providers.
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Affiliation(s)
- Kenneth Finlayson
- University of Central Lancashire, Research in Childbirth and Health (ReaCH) Group, Preston, Lancashire, United Kingdom
- * E-mail:
| | - Soo Downe
- University of Central Lancashire, Research in Childbirth and Health (ReaCH) Group, Preston, Lancashire, United Kingdom
| | - Joshua P. Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Maternal and Child Health Program, Burnet Institute, Melbourne, Australia
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Theunissen FJ, Chinery L, Pujar YV. Current research on carbetocin and implications for prevention of postpartum haemorrhage. Reprod Health 2018; 15:94. [PMID: 29945640 PMCID: PMC6019985 DOI: 10.1186/s12978-018-0529-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and is a significant contributor to severe maternal morbidity and long-term disability. Carbetocin may be an underused uterotonic for prevention of PPH. A number of studies are being conducted that may challenge the place of oxytocin as the first choice of uterotonics for prevention of PPH. This paper describes the current research into carbetocin and ranking of effectiveness of uterotonics that may provide important new information to assist healthcare decision makers to ensure that women receive an effective uterotonic for prevention of PPH. METHODS We searched the WHO International Clinical Trials Registry Platform for current studies on effectiveness of carbetocin for prevention of PPH following vaginal delivery with sample sizes large enough to provide quality evidence to support potential changes to international guidelines. We also searched the Cochrane Library for current systematic reviews including carbetocin used in prevention of PPH. RESULTS Susceptibility to degradation from exposure to heat is one of the key causes of reduced effectiveness of oxytocin in preventing PPH from uterine atony. Although heat stable and effective in preventing PPH, misoprostol is also subject to degradation due to exposure to moisture and produces some side-effects. Other uterotonics (including ergometrine and combinations of oxytocin, ergometrine and misoprostol) are also available and used with varying safety and effectiveness profiles and quality issues. Efforts to reduce maternal mortality from PPH include research studies seeking to identify safe, stable, effective uterotonics. Heat stable carbetocin is the subject of two major clinical studies into its effectiveness in preventing PPH following vaginal deliveries, information that could expand its application for prevention of PPH. CONCLUSION Heat stable carbetocin is being investigated as a potential alternative to oxytocin. This paper describes two current clinical trials on carbetocin and a network meta-analysis ranking of all uterotonic agents, including carbetocin, which combined may provide evidence supporting expansion of the use of the heat stable formulation of carbetocin in PPH prevention.
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Affiliation(s)
| | | | - Yeshita V. Pujar
- Department of Obstetrics & Gynaecology, KLE Academy of Higher Education and Research’s J. N. Medical College, Belagavi, Karnataka India
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Kartoglu U, Widmer M, Gulmezoglu M. Stability of oxytocin along the supply chain: A WHO observational study. Biologicals 2017; 50:117-124. [DOI: 10.1016/j.biologicals.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/28/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022] Open
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Fernando D, Siederer S, Singh S, Schneider I, Gupta A, Powell M, Richards D, McIntosh MP, Lambert P, Fowles S. Safety, Tolerability and Pharmacokinetics of Single Doses of Oxytocin Administered via an Inhaled Route in Healthy Females: Randomized, Single-blind, Phase 1 Study. EBioMedicine 2017; 22:249-255. [PMID: 28781129 PMCID: PMC5552226 DOI: 10.1016/j.ebiom.2017.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/06/2017] [Accepted: 07/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The utility of intramuscular (IM) oxytocin for the prevention of postpartum hemorrhage in resource-poor settings is limited by the requirement for temperature-controlled storage and skilled staff to administer the injection. We evaluated the safety, tolerability and pharmacokinetics (PK) of a heat-stable, inhaled (IH) oxytocin formulation. METHODS This phase 1, randomized, single-center, single-blind, dose-escalation, fixed-sequence study (NCT02542813) was conducted in healthy, premenopausal, non-pregnant, non-lactating women aged 18-45years. Subjects initially received IM oxytocin 10 international units (IU) on day 1, IH placebo on day 2, and IH oxytocin 50μg on day 3. Subjects were then randomized 4:1 using validated GSK internal software to IH placebo or ascending doses of IH oxytocin (200, 400, 600μg). PK was assessed by comparing systemic exposure (maximum observed plasma concentration, area under the concentration-time curve, and plasma concentrations at 10 and 30min post dose) for IH versus IM oxytocin. Adverse events (AEs), spirometry, laboratory tests, vital signs, electrocardiograms, physical examinations, and cardiac telemetry were assessed. FINDINGS Subjects were recruited between September 14, 2015 and October 12, 2015. Of the 16 subjects randomized following initial dosing, 15 (IH placebo n=3; IH oxytocin n=12) completed the study. IH (all doses) and IM oxytocin PK profiles were comparable in shape. However, systemic exposure with IH oxytocin 400μg most closely matched IM oxytocin 10IU. Systemic exposure was approximately dose proportional for IH oxytocin. No serious AEs were reported. No clinically significant findings were observed for any safety parameters. INTERPRETATION These data suggest that similar oxytocin systemic exposure can be achieved with IM and IH administration routes, and no safety concerns were identified with either route. The inhalation route may offer the opportunity to increase access to oxytocin for women giving birth in resource-poor settings.
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Affiliation(s)
- Disala Fernando
- GSK Clinical Unit Cambridge, Addenbrooke's Hospital NHS Trust, Cambridge, UK.
| | - Sarah Siederer
- Clinical Pharmacology Modelling and Simulation Department, GSK, Stevenage, Herts, UK.
| | | | - Ian Schneider
- GSK Clinical Unit Cambridge, Addenbrooke's Hospital NHS Trust, Cambridge, UK.
| | | | - Marcy Powell
- Clinical Safety, GSK, Research Triangle Park, NC, USA.
| | - Duncan Richards
- Alternative Discovery and Development, GSK, Stevenage, Herts, UK.
| | - Michelle P McIntosh
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia.
| | - Peter Lambert
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia.
| | - Susan Fowles
- Alternative Discovery and Development, GSK, Stevenage, Herts, UK
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Diop A, Daff B, Sow M, Blum J, Diagne M, Sloan NL, Winikoff B. Oxytocin via Uniject (a prefilled single-use injection) versus oral misoprostol for prevention of postpartum haemorrhage at the community level: a cluster-randomised controlled trial. LANCET GLOBAL HEALTH 2016; 4:e37-44. [PMID: 26718808 DOI: 10.1016/s2214-109x(15)00219-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 09/04/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Access to injectable uterotonics for management of postpartum haemorrhage remains limited in Senegal outside health facilities, and misoprostol and oxytocin delivered via Uniject have been deemed viable alternatives in community settings. We aimed to compare the efficacy of these drugs when delivered by auxiliary midwives at maternity huts. METHODS We did an unmasked cluster-randomised controlled trial at maternity huts in three districts in Senegal. Maternity huts with auxiliary midwives located 3-21 km from the closest referral centre were randomly assigned (1:1; via a computer-generated random allocation overseen by Gynuity Health Projects) to either 600 μg oral misoprostol or 10 IU oxytocin in Uniject (intramuscular), stratified by reported previous year clinic volume (deliveries) and geographical location (inland or coastal). Maternity huts that had been included in a previous study of misoprostol for prevention of postpartum haemorrhage were excluded to prevent contamination. Pregnant women in their third trimester were screened for eligibility either during community outreach or at home-based prenatal visits. Only women delivered by the auxiliary midwives in the maternity huts were eligible for the study. Women with known allergies to prostaglandins or pregnancy complications were excluded. The primary outcome was mean change in haemoglobin concentration measured during the third trimester and after delivery. This study was registered with ClinicalTrials.gov, number NCT01713153. FINDINGS 28 maternity hut clusters were randomly assigned-14 to the misoprostol group and 14 to the oxytocin group. Between June 6, 2012, and Sept 21, 2013, 1820 women were recruited. 647 women in the misoprostol group and 402 in the oxytocin group received study drug and had recorded pre-delivery and post-delivery haemoglobin concentrations, and overall 1412 women delivered in the study maternity huts. The mean change in haemoglobin concentrations was 3·5 g/L (SD 16·1) in the misoprostol group and 2·7 g/L (SD 17·8) in the oxytocin group. When adjusted for cluster design, the mean difference in haemoglobin decreases between groups was not significant (0·3 g/L, 95% CI -8·26 to 8·92, p=0·71). Both drugs were well tolerated. Shivering was common in the misoprostol group, and nausea in the oxytocin group. Postpartum haemorrhage was diagnosed in one woman allocated to oxytocin, who was referred and transferred to a higher-level facility for additional care, and fully recovered. No other women were transferred. INTERPRETATION In terms of effects on haemoglobin concentrations, neither oxytocin nor misoprostol was significantly better than the other, and both drugs were safe and efficacious when delivered by auxiliary midwives. The programmatic limitations of oxytocin, including short shelf life outside the cold chain, mean that misoprostol could be more appropriate for community-level prophylaxis of postpartum haemorrhage. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Bocar Daff
- Ministry of Health, Government of Senegal, Dakar, Senegal
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9
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Collins L, Mmari K, Mullany LC, Gruber CW, Favero R. An exploration of village-level uterotonic practices in Fenerive-Est, Madagascar. BMC Pregnancy Childbirth 2016; 16:69. [PMID: 27036886 PMCID: PMC4818420 DOI: 10.1186/s12884-016-0858-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Pharmaceutical uterotonics are effective for preventing postpartum hemorrhage and complications related to unsafe abortion. In Madagascar, however, traditional birth attendants (Matrones) commonly administer medicinal teas for uterotonic purposes. Little is known about Matrone practices and how they might coincide with efforts to increase uterotonic coverage. The aims of this study were to: 1) identify indications for presumed uterotonic plant use by Matrones, 2) explore uterotonic practices at the village level, and 3) describe the response of health practitioners to village-level uterotonic practices. Methods Twelve in-depth interviews with health practitioners, Matrones and community agents were conducted in local dialect. All interviews were audio-recorded, transcribed, and translated into English for analysis using Atlas.ti. Medicinal plant specimens were also collected and analyzed for the presence of uterotonic peptides. Results While Matrones reported to offer specific teas for uterotonic purposes, health practitioners discussed providing emergency care for women with complications associated with use of specific teas. Complications included retained placenta, hypertonic uterus, hemorrhage and sepsis. Chemical analysis indicated the presence of cysteine-rich peptides in the Dantoroa/Denturus plant used in some Matrones’ teas. Conclusions The presence of uterotonic peptides in one plant used by Matrones may indicate that Matrones intend to administer uterotonics for safer childbirth. This finding, combined with practitioner reports of complications related to some medicinal teas, points to a need for availability of an evidence-based uterotonic at the village level, namely, misoprostol pills or oxytocin in the form of uniject.
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Affiliation(s)
- Lillian Collins
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Kristin Mmari
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Christian W Gruber
- Medical University of Vienna, Center for Physiology and Pharmacology, Schwarzspanierstr. 17, A-1090, Vienna, Austria
| | - Rachel Favero
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231-3492, USA
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Torloni MR, Gomes Freitas C, Kartoglu UH, Metin Gülmezoglu A, Widmer M. Quality of oxytocin available in low- and middle-income countries: a systematic review of the literature. BJOG 2016; 123:2076-2086. [PMID: 27006180 DOI: 10.1111/1471-0528.13998] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oxytocin is the drug of choice for preventing and treating postpartum haemorrhage, an important cause of maternal death. Oxytocin is widely available in low and middle-income countries (LMIC) but there are concerns about its quality. OBJECTIVE To identify, critically appraise and synthesise the findings of studies on the quality of oxytocin available in LMIC. SEARCH STRATEGY We searched seven electronic databases, without language restriction. SELECTION CRITERIA Studies reporting results of tests to assess quality of oxytocin samples from LMIC. DATA COLLECTION AND ANALYSIS Study selection, data extraction and quality assessment were performed in duplicate. Results are presented descriptively. MAIN RESULTS The search identified 2611 unique citations; eight studies, assessing 559 samples from 15 different countries were included. Most samples were collected from facility level settings (n = 509) and from the private sector (n = 321). The median prevalence of oxytocin samples that failed quality tests was 45.6% (range 0-80%), mostly due to insufficient amounts of active pharmacological ingredient. Over one-third of the samples (n = 204) had low (<90%) oxytocin content indicating substandard medicine; two samples had no active ingredient, suggesting possible counterfeit drugs. The proportion of low fails was higher in samples collected in Africa than in Asia or Latin America (57.5% versus 22.3% versus 0%, respectively, P < 0.0001), in private than in public sectors (34.0% versus 25.3%, P = 0.032) and in facilities than in central distributors (37.9% versus 22.0%, P = 0.030). CONCLUSION There is a high prevalence of poor-quality oxytocin samples in LMIC countries, mainly due to inadequate amounts of active ingredient. TWEETABLE ABSTRACT Systematic review points to problems with quality of oxytocin samples from low- and middle-income countries.
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Affiliation(s)
- M R Torloni
- Evidence Based Healthcare Post-Graduate Programme, Department of Internal Medicine, São Paulo Federal University, São Paulo, Brazil
| | - C Gomes Freitas
- Evidence Based Healthcare Post-Graduate Programme, Department of Internal Medicine, São Paulo Federal University, São Paulo, Brazil
| | - U H Kartoglu
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - M Widmer
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Breuil V, Fontas E, Chapurlat R, Panaia-Ferrari P, Yahia HB, Faure S, Euller-Ziegler L, Amri EZ, Szulc P. Oxytocin and bone status in men: analysis of the MINOS cohort. Osteoporos Int 2015; 26:2877-82. [PMID: 26109496 DOI: 10.1007/s00198-015-3201-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Oxytocin, a neurohypophysial hormone, regulates bone metabolism in animal studies and postmenopausal women. In men, oxytocin is not associated with bone mineral density, bone turnover markers, or prevalent fractures, but weakly negatively with incident fragility fracture requiring further studies. INTRODUCTION We previously showed that serum oxytocin (OT) level is associated with bone mineral density (BMD) and bone turnover rate in postmenopausal women. The aim of our study was to assess the relationship between circulating OT levels and bone status in men. METHODS In 552 men aged 50 and older from the MINOS cohort, we measured serum levels of OT. We assessed the association of serum OT levels with BMD (lumbar, femoral neck, total hip), bone turnover markers (BTM) (serum N-terminal propeptide of type I procollagen (PINP), bone-specific alkaline phosphatase (bone ALP), and C-terminal telopeptide of type I collagen (CTX-I)) and fracture risk. RESULTS In the univariate analysis, serum OT level was not associated with BMD at any site, BTM levels, or with prevalent or incident fracture. OT was significantly correlated with body mass index (BMI) (r = 0.17, p < 0.001), total or bioavalaible 17β-estradiol (r = 0.09, p = 0.04 and r = 0.20, p < 0.001, respectively), free testosterone (r = 0.17, p < 0.001), and leptin (r = 0.16, p < 0.001). Multivariate analysis did not show significant relationship between serum OT and BMD. After adjustment for age, BMI, interaction BMI/age, history of fall in the last year, and BMD, OT and prevalent fracture were not associated. By contrast, the same analysis with additional adjustment for prevalent fracture showed a weakly significant negative association between OT and incident fracture, e.g., after adjustment for femoral neck BMD, HR = 0.73, 95 %CI 0.55-0.99, p = 0.04. CONCLUSION In men, serum OT levels are not associated with BMD, bone turnover rate, or prevalent fractures. The weak negative relationship with fracture risk requires further studies.
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Affiliation(s)
- V Breuil
- Nice University Hospital, Pasteur Hospital, Department of Rheumatology, Nice, F-06003, France.
- UMR E-4320 MATOs CEA/iBEB/SBTN, Université Nice Sophia Antipolis, Faculté de Médecine, Nice, France.
| | - E Fontas
- Nice University Hospital, Cimiez Hospital, Department of Clinical Research, Nice, F-06003, France
| | - R Chapurlat
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France
| | - P Panaia-Ferrari
- Nice University Hospital, Saint Roch Hospital, Department of Hormonology, Nice, F-06003, France
| | - H B Yahia
- Nice University Hospital, Saint Roch Hospital, Department of Hormonology, Nice, F-06003, France
- CNRS, iBV UMR 7277, 06100, Nice, France
- Inserm, iBV, U1091, 06100, Nice, France
| | - S Faure
- Nice University Hospital, Saint Roch Hospital, Department of Hormonology, Nice, F-06003, France
| | - L Euller-Ziegler
- Nice University Hospital, Pasteur Hospital, Department of Rheumatology, Nice, F-06003, France
| | - E Z Amri
- CNRS, iBV UMR 7277, 06100, Nice, France
- Inserm, iBV, U1091, 06100, Nice, France
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France
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12
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Moucheraud C, Gass J, Lipsitz S, Spector J, Agrawal P, Hirschhorn LR, Gawande A, Kodkany B. Bedside Availability of Prepared Oxytocin and Rapid Administration After Delivery to Prevent Postpartum Hemorrhage: An Observational Study in Karnataka, India. GLOBAL HEALTH: SCIENCE AND PRACTICE 2015; 3:300-4. [PMID: 26085025 PMCID: PMC4476866 DOI: 10.9745/ghsp-d-14-00239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postpartum hemorrhage is a leading cause of maternal death worldwide. Rapid provision of uterotonics after childbirth is recommended to reduce the incidence and severity of postpartum hemorrhage. Data obtained through direct observation of childbirth practices, collected in a study of the World Health Organization's Safe Childbirth Checklist in Karnataka, India, were used to measure if oxytocin prepared for administration and available at the bedside before birth was associated with decreased time to administration after birth. This was an observational study of provider behavior: data were obtained during a baseline assessment of health worker practices prior to introduction of the Safe Childbirth Checklist, representing behavior in the absence of any intervention. Analysis was based on 330 vaginal deliveries receiving oxytocin at any point postpartum. Oxytocin was prepared and available at bedside for approximately 39% of deliveries. We found that advance preparation and bedside availability of oxytocin was associated with increased likelihood of oxytocin administration within 1 minute after delivery (adjusted risk ratio = 4.89, 95% CI = 2.61, 9.16), as well as with decreased overall time to oxytocin administration after delivery (2.9 minutes sooner in adjusted models, 95% CI = -5.0, -0.9). Efforts to reduce postpartum hemorrhage should include recommendations and interventions to ensure advance preparation and bedside availability of oxytocin to facilitate prompt administration of the medicine after birth.
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Affiliation(s)
- Corrina Moucheraud
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA
| | - Jonathon Gass
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stuart Lipsitz
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, MA, USA
| | | | - Priya Agrawal
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Lisa R Hirschhorn
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
| | - Atul Gawande
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, MA, USA
| | - Bhala Kodkany
- Jawaharlal Nehru Medical College, Women's and Children's Health Research Unit, Karnataka, India
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13
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Abstract
Oxytocin-in-Uniject satisfied the standards of its temperature-time indicator (TTI) in severe home storage conditions, although that required resupply every 30 days—a logistically onerous programmatic standard. Possible advances include: (1) incorporating TTIs with packaged batches of less expensive and more widely used conventional vials of oxytocin; (2) using TTIs calibrated more closely to the actual temperature sensitivity of oxytocin; and (3) researching whether a lower dose of oxytocin would be equally efficacious in preventing postpartum hemorrhage.
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Affiliation(s)
- Stephen Hodgins
- Global Health: Science and Practice, Associate Editor for Maternal and Child Health
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