A descriptive study of healthcare-providers’ experiences with the use and quality of oxytocin for the prevention of post-partum hemorrhage in Nigeria: A nation-wide survey

Abstract

Background Oxytocin is recommended as an affordable and effective drug in the prevention of postpartum hemorrhage—one of the leading causes of maternal morbidity and mortality in low- and middle-income countries, however, there are concerns about its proper use and quality. This study builds on earlier work conducted in a South-Western state in Nigeria. Objective The study assessed the knowledge around oxytocin, usage, storage practices and perceived quality of oxytocin used by healthcare providers that directly administer oxytocin for the prevention of postpartum hemorrhage across Nigeria. Methods This was a descriptive cross-sectional study that surveyed a representative sample of 6,299 healthcare providers who offer obstetrics and gynecological services and recruited from 1,894 healthcare facilities in Public and Private sectors in 12 states across Nigeria. Data were collected using an electronic questionnaire, analyzed using SPSS, and presented in frequencies and percentages. Results Only forty-six percent of respondents (52.8% in private; 40.0% in public sector) had proper knowledge that oxytocin storage is in the refrigerator. Proper knowledge also varied by professional cadre, doctors (71.2%); nurses (46.6%); Community Health Workers (28.4%) and by years of experience, less than 10 years (51.4%); more than 10 years (40.8%). Only 34% of the respondents (41% in private and 27.5% in public sector) reported good practices that oxytocin is stored in the refrigerator in their facilities. Most healthcare providers used oxytocin for prevention of PPH (77.9%). Oxytocin was also used for augmentation (66.7%) and induction of labor (52.6%). Half of respondents used above the WHO-recommended oxytocin dose of 10IU for prevention of PPH. Twenty-three percent of respondents reported experiencing oxytocin failure in PPH prevention of whom, 54.3% changed to another uterotonic and 37.1% doubled the dose of oxytocin for their patients. Conclusion Our study findings should be used to establish clinical guidelines and trainings for healthcare providers to improve their knowledge and storage practices and use to safeguard the quality of these lifesaving medicines.

What do healthcare providers think of the quality of uterotonics? A mixed-methods systematic review

“…One24 of the three quantitative studies was categorised as being of high methodological quality. The other two studies23 27 were judged to be of moderate quality due to problems related to participant selection, sample size calculation and lack of CIs for the main results (online supplemental file 4).…”

“…Table 1 presents the main characteristics of the five included studies. All were conducted in 2010–2019; four studies were conducted in African countries (Ghana=1,38 Malawi=1,27 Nigeria=223 24) and one study25 was conducted in three countries (Ethiopia, India and Myanmar). All five studies assessed participants’ perception about the quality of oxytocin; one quantitative study27 also assessed perceptions about the quality of misoprostol.…”

“…Three surveys conducted in two African countries in 2017–2019 used different questionnaires to obtain the perceptions of a total of 7065 HCPs (61 in Malawi, 7004 in Nigeria) who worked in 2150 mixed (public and private) facilities (table 2 and online supplemental file 5). All quantitative studies23 24 27 contributed data to the perception of oxytocin quality, and one study27 provided data on perception of misoprostol quality. We decided not to combine results of the studies on perceived quality of oxytocin into a pooled meta-analysis of prevalence because each study used different types of non-validated questionnaires to assess this perception.…”

“…Therefore, we report the quantitative results narratively. The three studies reported administrative actions taken by HCPs in case they suspected medicines were of low quality, and two studies23 24 reported clinical actions taken when oxytocin was perceived to be of low quality. We did not pool results of quantitative studies on the administrative and clinical actions of participants who suspected that oxytocin or misoprostol was of low quality because the questions presented different types of situations (hypothetical scenario or real-life experience) and different types of answers, including more than one answer.…”

“…Two Nigerian studies23 24 inquired HCPs about the effectiveness of oxytocin for labour induction, augmentation or PPH prevention/treatment. In the first study, conducted in 2017, Ejekam et al 24 used written questionnaires to assess the perception of 705 participants (61% nurses and 39% doctors) who worked in 195 facilities in Lagos state about the quality of 12 popular brands of oxytocin.…”