Maternal health is a critical concern worldwide, with postpartum hemorrhage (PPH) being a leading cause of maternal mortality, especially in low- and middle-income countries (LMICs). Oxytocin, a vital drug for preventing and treating PPH, must be of high quality to be effective. This study evaluated the quality of oxytocin injections in health facilities across Addis Ababa, Ethiopia, and identified key factors that impact its quality, such as storage conditions and supply chain management. The findings highlight the importance of ensuring the availability of quality-assured oxytocin to improve maternal healthcare outcomes in LMICs.
Ensuring the Quality of Oxytocin: A Critical Maternal Health Concern
Postpartum hemorrhage (PPH) is a significant contributor to maternal mortality worldwide, accounting for nearly 20% of pregnancy-related deaths globally. This issue is particularly prevalent in low- and middle-income countries, where 99% of these deaths occur. Oxytocin, a hormone that stimulates uterine contractions, is the primary drug used to prevent and treat PPH. However, the quality of oxytocin available in many LMICs is often substandard, compromising its effectiveness and putting women’s lives at risk.
Evaluating Oxytocin Quality in Addis Ababa, Ethiopia
This study, conducted in Addis Ababa, the capital of Ethiopia, aimed to assess the quality of oxytocin injections and identify the factors that impact their quality. The researchers collected and analyzed 107 oxytocin samples from various health facilities, including government hospitals, private clinics, and supply chain hubs.
The findings revealed that 23.4% of the oxytocin samples failed to meet at least one quality standard, such as the required amount of active ingredient, sterility, or pH level. This failure rate was lower than in some other LMIC studies, likely due to the better infrastructure and power supply in Addis Ababa compared to more remote regions.
Factors Influencing Oxytocin Quality
The study identified several key factors that contributed to the substandard quality of oxytocin:
1. Storage conditions: Oxytocin samples stored in facilities with unreliable refrigeration, where the power was frequently interrupted for more than 24 hours, were 5.6 times more likely to fail quality tests than those stored in properly refrigerated conditions.
2. Supply chain management: Oxytocin samples distributed without an effective cold chain system, exposing them to high temperatures, were 5.5 times more likely to fail compared to those transported with proper temperature control.
3. Regulatory oversight: Oxytocin imported from manufacturers not approved by the national regulatory authority, the Ethiopian Food and Drug Authority (EFDA), were 3.2 times more likely to fail quality tests than those from registered and approved sources.
Improving Maternal Healthcare Outcomes
The findings of this study highlight the critical need to address the quality of oxytocin in LMICs like Ethiopia. Ensuring the availability of quality-assured oxytocin is essential for effective prevention and management of PPH, which is crucial for improving maternal healthcare outcomes.
To achieve this, the researchers recommend:
– Strengthening the national regulatory system: The EFDA should enforce stricter registration and quality control measures for imported oxytocin to prevent the entry of substandard products.
– Improving storage and distribution conditions: Health facilities must have reliable refrigeration and an effective cold chain system to maintain the quality of oxytocin throughout the supply chain.
– Enhancing comprehensive quality monitoring: Ongoing post-marketing surveillance and quality testing of oxytocin at all levels of the healthcare system are necessary to identify and address quality issues.
By addressing these key factors, the quality and accessibility of life-saving oxytocin can be improved, ultimately contributing to better maternal health outcomes in Ethiopia and other LMICs.
Author credit: This article is based on research by Atlaw Abate Alemie, Ebrahim Abdela Siraj, Gebremariam Birhanu Wondie, Dawit Regasa Soboka, Ashagrachew Tewabe Yayehrad.
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