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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