Uterotonic Use at Childbirth in Ghana: A Qualitative Study of Practices, Perceptions, and Knowledge Among Facility-Based Health Care Providers and Community Members

Abstract

PURPOSE: Uterotonic drugs, administered immediately after delivery, can prevent postpartum hemorrhage (PPH). As programs expand uterotonic access in settings of high maternal mortality, it is important to understand why and how these drugs are currently used. This qualitative study aimed to describe Ghanaian health care providers' and community members' knowledge, perceptions, and practices of uterotonic usage at or near labor and delivery. METHODS:In-depth interviews were conducted in 3 districts with 185 physicians, medical assistants, midwives, nurses, new mothers, mothers aged 50 years and older, traditional birth attendants, and chemists. FINDINGS:Providers described using misoprostol most commonly for labor induction, oxytocin for labor augmentation and PPH prevention, and ergometrine for PPH treatment. Unsafe practices and knowledge gaps were identified regarding labor augmentation and uterotonic storage. Community members reported experience with uterotonics in facility deliveries. Community-based use of pharmaceutical uterotonics was rarely reported, except misoprostol for pregnancy termination; however, community members described use of herbal medicines for intended uterotonic effect. Across respondent categories, uterotonics were more commonly associated with accelerating delivery than PPH prevention. CONCLUSION:Programs promoting facility childbirth and/or uterotonic coverage at home births should consider these underlying patterns of use and encourage safe practices through provider and community engagement.

A descriptive study of healthcare-providers’ experiences with the use and quality of oxytocin for the prevention of post-partum hemorrhage in Nigeria: A nation-wide survey

“…The CHWs were not included in the Lagos study. Nevertheless, previous studies in Ghana and Nepal reported similar findings that fewer healthcare providers from public facilities have proper knowledge on the storage of oxytocin in the refrigerator [ 28 , 32 ]. Other qualitative studies that assessed healthcare providers’ knowledge on oxytocin storage in other settings found that many had incorrect knowledge that oxytocin should be stored in room temperature or in the freezer [ 26 , 32 ].…”

“…Nevertheless, previous studies in Ghana and Nepal reported similar findings that fewer healthcare providers from public facilities have proper knowledge on the storage of oxytocin in the refrigerator [ 28 , 32 ]. Other qualitative studies that assessed healthcare providers’ knowledge on oxytocin storage in other settings found that many had incorrect knowledge that oxytocin should be stored in room temperature or in the freezer [ 26 , 32 ]. These findings have major programming implications in terms of raising awareness among healthcare providers that deliver babies on the importance of correct storage of oxytocin through the supply chain to maintain its effectiveness.…”

“…Reasons for this apparent poor practice have been reported as lack of knowledge among healthcare providers and medical storekeepers about the recommended storage condition and lack of mention or explanation of the recommended oxytocin storage conditions in their trainings or protocols in the clinics [ 28 ]. Even when healthcare providers are aware of the proper storage condition as also seen in the current study, factors beyond their control (e.g., lack of refrigerators and cold chain constraints from unreliable electricity) may affect their practices [ 26 , 32 ]. Prior studies have also shown that improper storage conditions of oxytocin in the supply chain is a major contributor to the poor-quality of oxytocin used in Nigeria and other LMICs [ 17 , 34 ].…”

“…These efforts should be accelerated to qualify alternative medicines such as Carbetocin for the prevention of PPH in LMICs, where refrigeration is a problem”. In addition, advocacy for the adoption of WHO, UNICEF, and UNFPA joint statement made in 2019 urging stakeholders to ensure that oxytocin is managed in cold chain of 2°C–8°C for distribution and storage, and label oxytocin packages to clearly indicate storage and transport requirements [ 26 , 32 ].…”

What do healthcare providers think of the quality of uterotonics? A mixed-methods systematic review

“…The two qualitative studies25 38 had minor methodological concerns due to lack or partial reflexivity statements, or data analysis method description (online supplemental file 3). One24 of the three quantitative studies was categorised as being of high methodological quality.…”