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

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

Victoria L Oliver  1 , Peter A Lambert  1 , Kyu Kyu Than  2   3 , Yasmin Mohamed  2 , Stanley Luchters  2   4   5 , Snigdha Verma  6 , Ranjana Yadav  6 , Vishwajeet Kumar  6 , Alula M Teklu  7 , Moti Tolera  8 , Abebaw Minaye  9 , Michelle P McIntosh  1
Affiliations

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

Victoria L Oliver et al. PLoS One. .

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.

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Conflict of interest statement

We have the following interests: VLO, PL and MPM are part of a product development team at Monash University, which is progressing the development of a heat stable oxytocin product for the prevention of PPH in resource-poor settings. Inhaled oxytocin is being developed through a product development collaboration agreement between Monash University and GlaxoSmithKline (GSK). GSK had no role in the funding, design or conduct of this study. AT is the founder and CEO of a for-profit research organisation (MERQ consultancy). For the conduct of this study, MT and AM were contracted by MERQ consultancy to provide services as outlined in the ‘author contribution’ section. MPM is the co-inventor of a worldwide patent application ‘Method and Formulation for Inhalation’ (WO 2013/016754) that covers the delivery of biologically active agents (including oxytocin) in the form of dry powders for inhalation. The authors have no commercial interest in the outcomes of this study or the introduction of the inhaled oxytocin product in low and lower-middle income countries. There are no further patents, products in development or marketed products relevant to this research study to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials."

References

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