Modeling patient access to therapeutic oxytocin in Zanzibar, Tanzania

Abstract

BackgroundOur objective is to estimate the effects of therapeutic oxytocin supply chain factors and social determinants of health on patient access to oxytocin in low-income settings using system dynamics modeling. Postpartum hemorrhage (PPH), a major cause of maternal mortality disproportionately affects women in low and middle income countries (LMICs). The World Health Organization recommends therapeutic oxytocin as the frontline uterotonic for PPH management and prevention. However, lack of access to quality therapeutic oxytocin in Tanzania, and throughout Sub-Saharan Africa, continues to result in a high number of preventable maternal deaths.MethodsWe used publicly available data from Zanzibar and Sub-Saharan Africa, literature review, oxytocin degradation kinetics and previously developed systems dynamics models to understand the barriers in patient access to quality therapeutic oxytocin.ResultsThe model makes four basic predictions. First, there is a major gap between therapeutic oxytocin procurement and availability. Second, it predicts that at current population increase rates, oxytocin supply will have to be doubled in the next 30 years. Third, supply and storage temperature until 30 °C has minimal effect on oxytocin quality and finally distance of 5 km or less to birthing facility has a small effect on overall access to oxytocin.ConclusionsThe model provides a systems level approach to therapeutic oxytocin access, incorporating supply and procurement, socio-economic factors, as well as storage conditions to understand how women’s access to oxytocin over time can be sustained for better health outcomes.

Tools for Supporting the MCH Workforce in Addressing Complex Challenges: A Scoping Review of System Dynamics Modeling in Maternal and Child Health

“…Nine works (~ 9%) created a model for this purpose. These were used to predict ambulatory health care demand (Diaz et al, 2012 ), the US urology workforce (McKibben et al, 2016 ), the prevalence of people with intellectual developmental disorders (Lee et al, 2016 ), the prevalence of Kawasaki disease (Huang et al, 2013 ), the Taiwanese pediatric workforce (Wu et al, 2013 ), the shortage of physicians in Japan (Ishikawa et al 2013 ), medical specialists needed in Sri Lanka (De Silva, 2017 ), nutrition status of the Colombian population (Meisel et al, 2018 ), and the supply of therapeutic oxytocin in Tanzania (Nadkarni et al, 2018 ).…”

“…Childhood obesity has also been a fruitful area for research crossover between MCH and SD; in this case, researchers may have been more comfortable using SD models because they are more common in the biomedical sciences. Collectively, these two fields of research (STI and childhood obesity) have only contributed thirty-five Pieters et al, 2011;Munar et al, 2015;Hernandez et al, 2016;Semwanga et al, 2016;Nadkarni et al, 2018, Pieters, van Oorschot et al 2018) End preventable deaths (Goal #3.2) 26 (Anderson & Anderson, 1998, Rwashana et al, 2009, Kumar & Kumar, 2014, Rwashana, Nakubulwa et al 2014, Munar et al, 2015, Batchelder & Lounsbury, 2016, Goncalves & Kamdem, 2016, Hontelez et al, 2016, Ozawa et al, 2016, Semwanga et al, 2016, Soler et al, 2016, Carrete et al, 2017, Page et al, 2017, Schuh et al, 2017, Shariatpanahi et al, 2017, Weeks et al, 2017, Meisel et al, 2018, Nadkarni et al, 2018, Owen et al, 2018, Tebbens & Thompson, 2018, Yourkavitch et al, 2018, Zou et al, 2018) End disease epidemics (Goal #3.3) 26 (Anderson & Anderson, 1998;Batchelder & Lounsbury, 2016;Batchelder et al, 2015;Evenden et al, 2006;Goncalves & Kamdem, 2016;Grove, 2015;Heidenberger & Flessa, 1993;…”