Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
Burnet Institute, Melbourne, Victoria, Australia.
PLoS One. 2018 Sep 25;13(9):e0203810. doi: 10.1371/journal.pone.0203810. eCollection 2018.
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.
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.
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.
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.
催产素是预防产后出血的金标准药物，但资源有限环境中的冷链系统限制可能严重影响这些环境中可用的催产素产品的质量。本研究调查了中低收入国家利益相关者对催产素、其储存要求和相关障碍以及可用产品质量的看法和做法。
在埃塞俄比亚、印度和缅甸进行了定性研究，通过焦点小组讨论（FGD）和深入访谈（IDI）收集数据。共进行了 12 次 FGD 和 106 次 IDI，参与者包括 158 名医疗保健提供者（药剂师、助产士、护士、医生和产科医生）和 40 名关键信息提供者（供应链专家、项目管理人员和政策制定者）。在 51 家医疗机构进行了催产素储存实践和冷链资源的直接观察。对 FGD 和 IDI 的逐字记录进行了英文翻译，并根据主题内容分析框架进行了分析。
在埃塞俄比亚，利益相关者普遍意识到催产素对热敏感以及药物需要冷藏储存，但在缅甸和印度的认识较为有限。所有研究地区的一个一致发现是，维持一致冷链的障碍很大，缺乏制冷设备和电力不可靠被认为是主要挑战。一些利益相关者在每个国家都表达了对催产素质量受损的看法。
在缅甸、埃塞俄比亚和印度，医疗保健提供者、政策制定者和供应链专家对催产素的热敏感性以及不一致的冷藏储存对产品质量的潜在影响的了解并不广泛。有必要开展有针对性的培训和宣传活动，强调冷藏储存对维持催产素质量的重要性。
