Clinical experiences with the use of oxytocin injection by healthcare providers in a South-Western State Nigeria: A Cross sectional study

Abstract

26Background: Post-Partum Hemorrhage (PPH), is a leading cause of maternal mortality in 27 Nigeria and most low and middle income countries (LMIC). The World Health 28 Organization(WHO) strongly recommends oxytocin as effective, affordable and the safest 29 drug of first choice in the prevention and treatment of PPH in the third stage of labor. 30 However, there are concerns about its quality. Very high prevalence of poor-quality oxytocin, 31 especially in Africa and Asia has been reported in literature. Excessive and inappropriate use 32 is also common with oxytocin in low-resource settings. 33 Objective: To assess clinical experiences with quality of oxytocin used by healthcare 34 providers in Lagos State Nigeria. 35 Methods: It was a descriptive cross-sectional study done in 2017. Seven hundred and five 36 respondents (doctors and nurses) who use oxytocin for obstetrics and gynaecological 37 services were recruited from 195 health facilities (public and registered private) across 38 Lagos State. Data collection was quantitative, using a pretested self-administered 39 questionnaire. Data analysis was done using IBM SPSS version 21. Statistical significance 40 was set at 5%( p<0.05). Ethical approval was obtained from Lagos University Teaching 41 Hospital Health Research Ethics Committee. Results: Only 52 percent of the respondents knew oxytocin should be stored at 2°C to 8°C.45 About 80% of the respondents used oxytocin for augmentation of labor; 68% for induction of 46 labor, 51% for stimulation of labor and 78% for management of PPH. Forty-one percent used 47 3 49 over a third (36%) of the respondents had an available means of documenting or reporting 50 perceived ineffectiveness of drugs in their facility. Of these, only about 12% had 51 pharmacovigilance forms available in their facilities to report the ineffectiveness. 52 Conclusion: The inappropriate and inconsistent use of oxytocin especially overdosing likely 53 led to the spuriously high perception of medicine effectiveness among respondents. This is 54 also coupled with lack of suspicion of medicine ineffectiveness by clinicians as a possible 55 root cause of poor treatment response or disease progression. Poor knowledge of oxytocin 56 storage and consequent poor storage practices could have contributed to the ineffectiveness 57 reported by some respondents. There is need for the establishment of a unified protocol for 58 oxytocin use with strict compliance to the guidelines. Continued training of healthcare 59 providers in medicines safety monitoring is advocated. 60 Pharmacovigilance and Lagos State.62 63 Background 64 Poor maternal and child health indices have remained a recurring public health challenge in 65 Nigeria. Obstetric haemorrhage especially post-partum haemorrhage (PPH) is a leading cause 66 of maternal mortality in Nigeria [1,2]. According to the world health organisation (WHO) 67 post-partum haemorrhage (PPH) is defined as a blood loss of 500 ml or more within 24 hours 68 after birth and it is said to affect approximately 2% of ...