Knowledge, perception and practice towards oxytocin stability and quality: A qualitative study of stakeholders in three resource-limited countries

PLoS One. 2018 Sep 25;13(9):e0203810. doi: 10.1371/journal.pone.0203810. eCollection 2018.

Abstract

Background: Oxytocin is the gold standard drug for the prevention of postpartum haemorrhage, but limitations in cold chain systems in resource-constrained settings can severely compromise the quality of oxytocin product available in these environments. This study investigated the perspectives and practices of stakeholders in low and lower-middle income countries towards oxytocin, its storage requirements and associated barriers, and the quality of product available.

Methods: Qualitative inquiries were undertaken in Ethiopia, India and Myanmar, where data was collected through Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs). A total of 12 FGDs and 106 IDIs were conducted with 158 healthcare providers (pharmacists, midwives, nurses, doctors and obstetricians) and 40 key informants (supply chain experts, program managers and policy-makers). Direct observations of oxytocin storage practices and cold chain resources were conducted at 51 healthcare facilities. Verbatim transcripts of FGDs and IDIs were translated to English and analysed according to a thematic content analysis framework.

Findings: Stakeholder awareness of oxytocin heat sensitivity and the requirement for cold storage of the drug was widespread in Ethiopia but more limited in Myanmar and India. A consistent finding across all study regions was the significant barriers to maintaining a consistent cold chain, with the lack of refrigeration facilities and unreliability of electricity cited as major challenges. Perceptions of compromised oxytocin quality were expressed by some stakeholders in each country.

Conclusion: Knowledge of the heat sensitivity of oxytocin and the potential impacts of inconsistent cold storage on product quality is not widespread amongst healthcare providers, policy makers and supply chain experts in Myanmar, Ethiopia and India. Targeted training and advocacy messages are warranted to emphasise the importance of cold storage to maintain oxytocin quality.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Cold Temperature
  • Developing Countries
  • Drug Stability
  • Drug Storage / methods*
  • Drug Storage / standards
  • Ethiopia
  • Female
  • Focus Groups
  • Health Knowledge, Attitudes, Practice
  • Humans
  • India
  • Interviews as Topic
  • Myanmar
  • Oxytocin / chemistry*
  • Oxytocin / standards*
  • Oxytocin / therapeutic use
  • Postpartum Hemorrhage / prevention & control
  • Pregnancy
  • Rural Health Services
  • Urban Health Services

Substances

  • Oxytocin

Grants and funding

This study was made possible by the generous support of the Saving Lives at Birth partners: the United States Agency for International Development (USAID), the Government of Norway, the Bill and Melinda Gates Foundation, Grand Challenges Canada, and the UK Government https://savinglivesatbirth.net/; grant number: AIDOAA-F-14-00046). This funder provided support in the form of salary costs for author VO. The funder also provided support for research costs in all three countries, which included contributions to salary costs for KKT, SV, RY, AT, MT and AM. Funding support for the salary of PL was provided by the McCall MacBain Foundation (http://www.mccallmacbain.org/). Additional funding for non-salary research costs in Ethiopia was provided by Grand Challenges Canada and the Government of Canada (http://www.grandchallenges.ca/; grant number: TTS 0609-05). The authors gratefully acknowledge the contribution of the Victorian Operational Infrastructure Support Program (https://www2.health.vic.gov.au/about/clinical-trials-and-research/operational-infrastructure-support), which provided funding to the Burnet Institute to support research in Myanmar. Australia’s National Health and Medical Research Council (https://www.nhmrc.gov.au/; grant number: GNT1090805) provided funding in the form of a Career Development Fellowship for SL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of authors are articulated in the ‘author contributions’ section. AT is the founder and CEO of a for-profit research organisation (MERQ consultancy). MT and AM were contracted by MERQ consultancy to provide services for the conduct of this study. MERQ consultancy undertook research in Ethiopia on a fee-for-service basis and provided no direct or in-kind financial support for the study. Beyond the roles of AT, MT and AM (articulated in the authors' contribution section) MERQ did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.