Nadkarni Devika, Gravelyn Sara, Brova Monica, Rashid Sarem, Yee Randy, Guttieres Donovan, Clifford Katie, Desai Darash, Zaman Muhammad
Department of Biomedical Engineering, Boston University, 38 Cummington Street, Boston, MA, 02215, USA.
BMC Health Serv Res. 2018 Aug 17;18(1):645. doi: 10.1186/s12913-018-3452-8.
Our objective is to estimate the effects of therapeutic oxytocin supply chain factors and social determinants of health on patient access to oxytocin in low-income settings using system dynamics modeling. Postpartum hemorrhage (PPH), a major cause of maternal mortality disproportionately affects women in low and middle income countries (LMICs). The World Health Organization recommends therapeutic oxytocin as the frontline uterotonic for PPH management and prevention. However, lack of access to quality therapeutic oxytocin in Tanzania, and throughout Sub-Saharan Africa, continues to result in a high number of preventable maternal deaths.
We used publicly available data from Zanzibar and Sub-Saharan Africa, literature review, oxytocin degradation kinetics and previously developed systems dynamics models to understand the barriers in patient access to quality therapeutic oxytocin.
The model makes four basic predictions. First, there is a major gap between therapeutic oxytocin procurement and availability. Second, it predicts that at current population increase rates, oxytocin supply will have to be doubled in the next 30 years. Third, supply and storage temperature until 30 °C has minimal effect on oxytocin quality and finally distance of 5 km or less to birthing facility has a small effect on overall access to oxytocin.
The model provides a systems level approach to therapeutic oxytocin access, incorporating supply and procurement, socio-economic factors, as well as storage conditions to understand how women's access to oxytocin over time can be sustained for better health outcomes.
我们的目标是使用系统动力学模型，评估治疗用催产素供应链因素和健康的社会决定因素对低收入环境下患者获取催产素的影响。产后出血（PPH）是孕产妇死亡的主要原因，对低收入和中等收入国家（LMICs）的妇女影响尤为严重。世界卫生组织推荐治疗用催产素作为PPH管理和预防的一线宫缩剂。然而，在坦桑尼亚以及整个撒哈拉以南非洲，缺乏获得优质治疗用催产素的途径，仍然导致大量可预防的孕产妇死亡。
我们使用了来自桑给巴尔和撒哈拉以南非洲的公开数据、文献综述、催产素降解动力学以及先前开发的系统动力学模型，以了解患者获取优质治疗用催产素的障碍。
该模型做出了四个基本预测。第一，治疗用催产素的采购与可获得性之间存在重大差距。第二，它预测，按照目前的人口增长率，催产素供应在未来30年内将不得不翻倍。第三，在30°C以下的供应和储存温度对催产素质量影响最小，最后，距离分娩设施5公里或更近对催产素的总体获取影响较小。
该模型提供了一种系统层面的方法来获取治疗用催产素，纳入了供应与采购、社会经济因素以及储存条件，以了解如何随着时间的推移维持妇女获取催产素的机会，从而实现更好的健康结果。
