(063) The quality, supply chain, and use of uterotonics in the zone of influence in the Northern region of Ghana – a survey from healthcare providers’ perspective

Publication Number: 726

Background: Uterotonics are recommended for all births for effective management of postpartum hemorrhage (PPH) – a preventable but leading causes of maternal morbidity and mortality in low- and middle-income countries (LMICs) including Ghana. However, their quality and proper use by healthcare providers (HCP) remain a concern.

Objectives: To assess the supply chain system, quality and usage pattern of uterotonics that are provided to pregnant women and during childbirth by HCP.

Methods: This was a descriptive cross-sectional study that surveyed a representative sample of 800 HCPs - who administer uterotonics to their clients or involved in the supply chain management of the medicines in the health facilities(HCF), from 298 HCFs (public and private HCFs) in the four regions of Northern Ghana - Northern, North-East, Upper East.The main outcome measures were the knowledge of correct storage and use of the uterotonics by HCPs and the practices of correct storage of uterotonics at the HCFs. Data was collected using mixed method - interviewer-administered electronic questionnaire and objective verification, analyzed using STATA17 and presented in frequencies and percentages. Statistical significance was set at p< 0.05. Ethical approval was obtained from Ghana Health Services Ethics Review Committee.

Results: Majority (97.5%) of the respondents knew that oxytocin should be stored at 2°- 8°C while 63.0% knew that misoprostol should be stored at room temperature in a dry area.
Oxytocin was most used for the prevention of PPH (97.6%); ergometrine - treatment of PPH (71.4%); and misoprostol - treatment of PPH (64.0%). 49.0% of the oxytocin samples available at the HCFs were sourced from the Regional medical stores and 18.0% were from the open market while 55.7% of the misoprostol were sourced from the open market.
Majority (89.8%) of the respondents use 10IU of oxytocin for the prevention of PPH while 6.3% use 20IU – double the recommended dose. Only 16% of the respondents use the recommended 600 µg of misoprostol for the prevention of PPH. Of the 89.6% of HCPs that had stored their oxytocin in refrigerators, only 62.0% were within 2-8oC on verification of the storage temperature in the HCFs. For misoprostol, out of 86.0% that stored in a dry place at room temperature, only 22.8% had temperatures within the recommended storage of ≤30°C and 7.4% stored in a relative humidity of 55-65%.

Conclusions: Our survey unveiled sub-optimal storage conditions/practices around uterotonics with poor availability of misoprostol at HCFs inaddition to gap around the knowledge and use. There is evidence of potential pointers to poor-quality uterotonics - inappropriate dose administration of uterotonics, verified inappropriate storage conditions, multiple use of uterotonics, sources of uterotonics at HCFs. Therefore, continuous training of HCPs, availability of temperature/humidity data-loggers at the HCFs and improved procurement practices are strongly recommended to ensure good quality uterotonics.