Poor storage of Oxytocin endangers lives of women at childbirth
Nigeria’s unenviable position of second highest maternal mortality rate in the world may be substantially addressed, when efforts are increased to ensure the quality of medicine administered to women at the point of putting to bed.
This is particularly important in the case of Oxytocin, a medicine used during labour to cause contraction of the uterus to start labour, increase the speed of labour, and to stop bleeding following delivery. In Nigeria, it appears there are quality issues, arising not just possibly from manufacturers, but also in handling and storage of Oxytocin.
BusinessDay correspondent while interacting with some experts at the Medicine Quality and Public Health Conference in Oxford, learnt that a lot of Oxytocin in Nigerian hospitals have quality issues on account of storage, resulting in multiple doses having to be used when women go into labour.
“When a woman is given a drug and it doesn’t contain what it should, then the uterus would not contract. Healthcare workers can detect when this happens and will see that women are continuing to bleed through those blood vessels that have been left open after the baby has been born. So, what they are doing is often using two, three, four doses of Uteritonics to get those uterine contractions to stop this bleeding,” Fiona Theunissen, program manager for maternal health at Concept Foundation told BusinessDay.
Moji Adeyeye, director general, National Agency for Food and Drug Administration and Control (NAFDAC), noted that a study conducted by the agency in collaboration with USP revealed “About 70 percent of the Oxytocin in the market or in the hospitals have degraded because of climatic condition in storage.”
Adeyeye emphasised the imperative for enlightenment by going to the different hospitals or institutions to talk with nurses, pharmacists and doctors.
“They think that it can be put in room temperature and it is okay. No, there has to be a cold chain storage,” she said.
Her position is corroborated by Conept Foundation’s Theunissen, who said “There is widespread belief that Oxytocin does not need to be kept in the cold chain. So, in Nigeria for example and a number of other countries, Oxytocin is procured from manufacturers that have labelled the product store at room temperature or store at twenty degrees, store under thirty degrees.
“The WHO does not recognise this labelling as being correct for Oxytocin,” Theunissen stressed.
The misconception that the product can be left on the shelves implies there is a very good chance that it is not going to work as efficiently as it should. When this happens without the medical team being able to control bleeding and other complications that may arise, expectant mothers could end up losing their lives.
Chioma Ejekam, a public health physician, in the department of community health, Lagos University Teaching Hospital (LUTH), in an interview with BusinessDay, discussed findings of a research on Oxytocin, in which she participated, revealing a culture of poor storage in many hospitals.
She explained that many of the medical personnel surveyed had experienced use of ineffective brands of Oxytocin and nothing is being done about it. The major problem that was discovered is degradation, particularly due to lack of cold storage practices in the supply chain and even the health facilities.
“It was evident that a lot of our healthcare providers did not know the proper storage for Oxytocin is in cold chain temperature,” Ejekam said.
The solution from submissions by several experts, points to proper storage of this important medicine which could save women a lot of pain during childbirth, and even possibly save them from dying on account of excessive bleeding. Apart from medical workers who have been said to store the medicine in poor conditions, dealers in medical products also need to do more, experts say.
Chimezie Anyakowa, chief of party, United States Pharmacopeia (USP) in Nigeria, stressed the importance of consistent market surveillance, which according to him will keep those in the supply chain on their toes. This, he says, will ensure the medicine is properly stored to avoid degradation.
“Once people who peddle these fake medicines know that somebody is watching, it is not easy for them to do it anymore. In addition, most people do not know that the medicines they supply are of poor quality because of the storage condition they did not know about. Through post-marketing surveillance these can be detected, and corrected (where possible),” said Anyakowa.
CALEB OJEWALE