An Implementation Research Study on Uterotonics Use Patterns and Heat-stable Carbetocin Acceptability and Safety for Prevention of Postpartum Hemorrhage in Nigeria.

Autor:	Amode OA; Sexual Reproductive, Maternal and Newborn Care Program, Clinton Health Access Initiative, Minna, Nigeria., Negedu OV; Sexual Reproductive Health Program, Clinton Health Access Initiative, Maitama, Abuja, Nigeria., Joseph JT; Global Health Sciences Analytics and Implementation Research, Clinton Health Access Initiative, Suite, Boston, United States., Igbokwe U; Health Systems Consulting, Solina Center for International Development and Research, Abuja, Nigeria., Adekeye O; Country Programs Benin, Clinton Health Access Initiative, Fifadji-Houto, Akpakpa, Cotonou, Benin., Oyedele DK; Sexual Reproductive Health Program, Clinton Health Access Initiative, Victoria Island, Nigeria., Salele H; Community Based Health Information Management Systems (CBHMIS), Maternal and Newborn Health Programs, Clinton Health Access Initiative, Abuja, Nigeria., Ameyan L; Maternal and Newborn Health Programs, Clinton Health Access Initiative, Maitama, Abuja, Nigeria., Afolabi K; Reproductive Health, Federal Ministry of Health, Shehu Shagari Way, Central Business District, Abuja, Nigeria., Fasawe O; Sexual Reproductive Health Program, Clinton Health Access Initiative, Maitama, Abuja, Nigeria., Wiwa O; Global Resources for Health West and Central Africa & Country Programs Nigeria, Clinton Health Access Initiative, Maitama, Abuja, Nigeria.
Jazyk:	angličtina
Zdroj:	International journal of MCH and AIDS [Int J MCH AIDS] 2024 Sep 23; Vol. 13 (Suppl 1), pp. S38-S45. Date of Electronic Publication: 2024 Sep 23 (Print Publication: 2024).
DOI:	10.25259/IJMA_1_2024
Abstrakt:	Background and Objective: The burden of maternal mortality attributable to postpartum hemorrhage (PPH) remains high in Nigeria. Currently, oxytocin, and misoprostol, which are largely of suboptimal quality, are used for PPH prevention and treatment. Heat-stable carbetocin (HSC) is a viable uterotonic option for PPH prevention in a setting like Nigeria where compromised supply and cold chain systems result in the preponderance of poor-quality oxytocin and suboptimal PPH management. It is crucial to understand how healthcare providers (HCPs) accept and use HSC for PPH prevention, and what factors encourage correct uterotonic usage in health facilities, given PPH's ongoing public health challenge. This study aims to elucidate the current prophylactic use of HSC, oxytocin, and misoprostol in secondary and tertiary public health facilities while assessing HSC acceptability to clinicians and establishing factors that enable the appropriate use of uterotonics in health facilities. Methods: Descriptive analysis conducted on quantitative data from patient chart reviews, HCP interviews and assessment, and facility assessment using Stata 15 and Microsoft Excel are presented as counts and percentages, while qualitative data from key informant interviews and in-depth interviews are coded and analyzed using NVivo. The findings from 18 publicly owned secondary and tertiary healthcare facilities across Kano, Lagos, and Niger states in Nigeria were interpreted according to thematic areas. Health facilities selection criteria were high volume of deliveries (≥30 deliveries per month), accessible location, availability of trained HCPs (specifically doctors, nurses, and midwives), and willingness to participate in the study. Results: HSC was administered prophylactically in 10,284 (56%) of 18,364 deliveries, with a total of 148 (0.8%) women developing PPH. Approximately 76% of HCPs preferred HSC for PPH prevention compared to other available uterotonics, with clinical guidance from senior HCPs (76%), in-service training (76%), mentoring (84%), and supportive supervision (75%) contributing significantly to the choice and practice of uterotonics use by HCPs. Conclusion and Global Health Implications: HSC, a thermostable analog of oxytocin, holds the potential to prevent PPH without the added cost of administering additional uterotonics and interventions. The introduction of HSC requires concerted procurement and capacity-building efforts to create an enabling environment for scale-up. HSC is non-inferior to oxytocin in preventing PPH, has few side effects compared to misoprostol or oxytocin-misoprostol combination, and more cost-effective when compared with the other three uterotonics. Although the geographical scope of our study is only three states in Nigeria, the preponderance of suboptimal uterotonics across the country makes our findings applicable to the whole country and other low- and middle-income countries with similar challenges. Competing Interests: The authors have no conflicts of interest. (© 2024 The Authors. Published by Global Health and Education Projects, Inc., USA.)
Databáze:	MEDLINE
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