Clinical experiences with the use of oxytocin injection by healthcare providers in a South-Western State Nigeria: A Cross sectional study.

Background: Post-Partum Hemorrhage (PPH), is a leading cause of maternal mortality in Nigeria and most low and middle income countries(LMIC). The World Health Organization(WHO) strongly recommends oxytocin as effective, affordable and the safest drug of first choice in the prevention and treatment of PPH in the third stage of labor. However, there are concerns about its quality. Very high prevalence of poor-quality oxytocin, especially in Africa and Asia has been reported in literature. Excessive and inappropriate use is also common with oxytocin in low-resource settings. Objective: To assess clinical experiences with quality of oxytocin used by healthcare providers in Lagos State Nigeria. Methods: It was a descriptive cross-sectional study done in 2017. Seven hundred and five respondents (doctors and nurses) who use oxytocin for obstetrics and gynaecological services were recruited from 195 health facilities (public and registered private) across Lagos State. Data collection was quantitative, using a pretested self-administered questionnaire. Data analysis was done using IBM SPSS version 21. Statistical significance was set at 5%( p<0.05). Ethical approval was obtained from Lagos University Teaching Hospital Health Research Ethics Committee. Funding support was provided by the Promoting the Quality of Medicines, a program funded by the U.S. Agency for International Development and implemented by the U.S. Pharmacopeia Convention. Results: Only 52 percent of the respondents knew oxytocin should be stored at 2°C to 8°C. About 80% of the respondents used oxytocin for augmentation of labor; 68% for induction of labor, 51% for stimulation of labor and 78% for management of PPH. Forty-one percent used 20IU and as much as 10% used 30IU to 60IU for management of PPH. About 13% of the respondents have experienced use of an ineffective brand of oxytocin in their practice. Just over a third (36%) of the respondents had an available means of documenting or reporting perceived ineffectiveness of drugs in their facility. Of these, only about 12% had pharmacovigilance forms available in their facilities to report the ineffectiveness. Conclusion: The inappropriate and inconsistent use of oxytocin especially overdosing likely led to the spuriously high perception of medicine effectiveness among respondents. This is also coupled with lack of suspicion of medicine ineffectiveness by clinicians as a possible root cause of poor treatment response or disease progression. Poor knowledge of oxytocin storage and consequent poor storage practices could have contributed to the ineffectiveness reported by some respondents. There is need for the establishment of a unified protocol for oxytocin use with strict compliance to the guidelines. Continued training of healthcare providers in medicines safety monitoring is advocated.