Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Quality medicines in maternal health: results of oxytocin, misoprostol, magnesium sulfate and calcium gluconate quality audits

Authors: Chimezie Anyakora, Yetunde Oni, Uchenna Ezedinachi, Adebola Adekoya, Ibrahim Ali, Charles Nwachukwu, Charles Esimone, Victor Abiola, Jude Nwokike

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Login to get access

Abstract

Background

The high level of maternal mortality and morbidity as a result of complications due to childbirth is unacceptable. The impact of quality medicines in the management of these complications cannot be overemphasized. Most of those medicines are sensitive to environmental conditions and must be handled properly. In this study, the quality of oxytocin injection, misoprostol tablets, magnesium sulfate, and calcium gluconate injections was assessed across the six geopolitical zones of Nigeria.

Method

Simple, stratified random sampling of health facilities in each of the political zones of Nigeria. Analysis for identification and content of active pharmaceutical ingredient was performed using high-performance liquid chromatography procedures of 159 samples of oxytocin injection and 166 samples of misoprostol tablets. Titrimetric methods were used to analyze 164 samples of magnesium sulfate and 148 samples of calcium gluconate injection. Other tests included sterility, pH measurement, and fill volume.

Results

Samples of these commodities were procured mainly from wholesale and retail pharmacies, where these were readily available, while the federal medical centers reported low availability. Approximately, 74.2% of oxytocin injection samples failed the assay test, with the northeast and southeast zones registering the highest failure rates. Misoprostol tablets recorded a percentage failure of 33.7%. Magnesium sulfate and Calcium gluconate injection samples recorded a failure rate of 6.8% and 2.4%, respectively.

Conclusion

The prevalence of particularly of oxytocin and misoprostol commodities was of substandard quality. Strengthening the supply chain of these important medicines is paramount to ensuring their effectiveness in reducing maternal deaths in Nigeria.
Literature
1.
2.
WHO (World Health Organization). b. Trends in Maternal Mortality: 1990 to 2013, Estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations population division. Geneva: WHO; 2014.
3.
Filippi V, Chou D, Ronsmans C, Graham W, Say L. Levels and Causes of Maternal Mortality and Morbidity. In: Black ER, Laxminarayan R, Temmerman M, Walker N, editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities Third Edition, vol. 2. Washington DC: The International Bank for Reconstruction and Development/The World Bank; 2016. Chapter 3.
4.
Hamid R. Misoprostol: an essential medicine for managing postpartum hemorrhage in low-resource settings? Int J Gynecol Obstet. 2011;114(3):209–10.CrossRef
5.
Say L, Chou D, Gemmill A, Tuncalpo O, Moller A-B, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.CrossRefPubMed
6.
Kumar N. Postpartum Hemorrhage; a Major Killer of Woman: Review of Current Scenario. Obstet Gynecol Int J. 2016;4(4):00116.CrossRef
7.
Olowokere AE, Adekeye OA, et al. The prevalence, management and outcome of primary postpartum haemorrhage in selected health care facilities in Nigeria. International Journal of Nursing and Midwifery. 2013;5(3):28–34.CrossRef
8.
9.
10.
Walraven G, Blum J, Dampha Y, Sowe M, Morison L, Winikoff B. Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia; a randomised controlled trial. International Journal of Obstetrics and Gynaecology. 2005;112:1277–83.CrossRef
11.
Chandhiok N, Dhillon BS, Datey S, Mathur A, Saxena AC. Oral misoprostol for prevention of postpartum hemorrhage by paramedical workers in India. Int J Gynaecol Obstet. 2006;92:170–5.CrossRefPubMed
12.
Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database of Systematic Reviews 2014, Issue 2.
13.
Frass KA. Postpartum haemorrhage is related to the haemoglobin levels at labor: observational study. Alexandria Journal of Medicine. 2015;51(4):333–7.CrossRef
14.
Kavle JA, Stoltzfus RJ, Witter F, Tielsch JM, Khalfan SS, Caulfield LE. Association between Anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibat, Tanzania. J Health Popul Nutr. 2008;26(2):232–40.PubMedPubMedCentral
15.
16.
Jhpiego. 2014. Business case: investing in production of high-quality oxytocin for low-resource settings. Publication prepared by C. Schocken through the Reproductive Health Supplies Coalition. Available at http://​reprolineplus.​org/​oxytocin-case. Accessed 3 Aug 2016.
17.
18.
United Nations. United Nations Commission on life-saving Commodities for Women and Children; Commissioner's report 2012. New York: United Nations; 2012.
19.
20.
Karikari BE. Post-market quality surveillance project maternal health care products on the Ghanaian market. Ghana Food and Drugs Authority: Accra; 2013.
21.
Torloni MR, Gomes FC, Kartoglu UH, Metin GA, Widmer M. Quality of oxytocin available in low- and middle-income countries: a systemic review of the literature. Br J Obstet Gynaecol. 2016;123(13):2076–86.CrossRef
22.
23.
Hofmeyr GJ, Ferreira S, Nikodem VC, et al. Misoprostol for treating postpartum haemorrhage: a randomized controlled trial. BMC Pregnancy and Childbirth. 2004;4:16.CrossRefPubMedPubMedCentral
24.
McCormick ML, Sanghvi HC, Kinzie B, McIntosh N. Preventing postpartum haemorrhage in low-resource settings. Int J Gynaecol Obstet. 2002;77:267–75.CrossRefPubMed
25.
Alfirevic A, Blum J, Walraven G, Weeks A, Winikoff B. Prevention of postpartum hemorrhage with misoprostol. Int J Gynecol Obstet. 2007;99(Suppl 2):198–201.CrossRef
26.
Oladapo, Olufemi T. Misoprostol for preventing and treating postpartum hemorrhage in the community: A closer look at the evidence. International Journal of Gynecology and Obstetrics. 2012;119(2):105–11.CrossRefPubMed
27.
Caliskan E, Dilbaz B, Meydanli MM, Ozturk N, Narin MA, Haberal A. Oral Misoprostol for the third stage of labor: a randomized controlled trial. Obstet Gynecol. 2003;101(5 pt 1):921–8.CrossRefPubMed
28.
Norman JE, Thong KJ, Baird DT. Uterine contractility and induction of abortion in early pregnancy by misoprostol and mifepristone. Lancet. 1991;338:1233–6.CrossRefPubMed
29.
Hofmeyr GJ, Ferreira S, Nikodem VC, et al. Misoprostol for treating postpartum haemorrhage: a randomized controlled trial [ISRCTN72263357]. BMC Pregnancy and Childbirth. 2004;4:16.CrossRefPubMedPubMedCentral
30.
Moodley J, Daya P. Eclampsia: a continuing problem in developing countries. Int J Gynecol Obstet. 1994;44(1):9–14.CrossRef
31.
Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi J-M. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag. 2011;7:467–74.PubMedPubMedCentral
32.
American College of Obstetricians and Gynecologists. ACOG practice bulletin: Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol. 2002;99(1):159–67.
33.
34.
35.
Oladapo OT, Lamina MA, Fakoya TA. Maternal deaths in sagamu in the new millennium: a facility-based retrospective analysis. BMC Pregnancy Childbirth. 2006;6:6.CrossRefPubMedPubMedCentral
36.
Society of Gynaecology and Obstetrics of Nigeria: Status of emergency obstetric service in six states of Nigeria – A needs assessment report, 2004.
37.
Tukur J, Rai’u, Gill KS. Pattern of eclampsia in a tertiary health facility situated in a semi-rural town in northern Nigeria. Annals of African Medicine. 2008;6(4):164–7.CrossRef
38.
Moser M. Working Group Report on High Blood Pressure in Pregnancy. J Clin Hypertens. 2001;3:75–88.CrossRef
39.
ACOG Committee On obstetric practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. No. 33, January 2002. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2002;99:159–67.CrossRef
40.
Duley L, Gülmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2003;2:CD000025.
41.
Magpie Trial Collaboration Group. Do women with preeclampsia, and their babies, benefit from magnesium sulphate? The magpie trial: a randomised placebo controlled trial. Lancet. 2002;359:1877–90.CrossRef
42.
Australian Medicines Handbook. Magnesium sulphate: Drugs in pre-eclampsia and eclampsia: AMH. 2014.
43.
Agus ZS, Lau K. Disorders of magnesium metabolism. In: Arieff AI, RA DF, editors. Fluid, electrolyte, and acid-base disorders. 2nd ed. New York: Churchill Livingstone; 1995. p. 475–92.
44.
Burridge N, Collard N, Symons K and Society of Hospital Pharmacists of Australia (issuing body). Australian injectable drugs handbook (Sixth edition). Collingwood, Vic: The Society of Hospital Pharmacists of Australia; 2014.
Metadata
Title
Quality medicines in maternal health: results of oxytocin, misoprostol, magnesium sulfate and calcium gluconate quality audits
Authors
Chimezie Anyakora
Yetunde Oni
Uchenna Ezedinachi
Adebola Adekoya
Ibrahim Ali
Charles Nwachukwu
Charles Esimone
Victor Abiola
Jude Nwokike
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1671-y

Other articles of this Issue 1/2018

BMC Pregnancy and Childbirth 1/2018 Go to the issue

Research article

Lower vitamin D levels in Saudi pregnant women are associated with higher risk of developing GDM

Research article

Availability and affordability of priority life-saving medicines for under-five children in health facilities of Tigray region, northern Ethiopia

Research article

Births and induced abortions among women of Russian, Somali and Kurdish origin, and the general population in Finland –comparison of self-reported and register data

Research article

Three-dimensional power Doppler ultrasound evaluation of placental blood flow in normal monochorionic diamniotic twin pregnancies

Research article

Preeclampsia by maternal reasons for immigration: a population-based study

Research article

Sociocultural determinants of nomadic women’s utilization of assisted childbirth in Gossi, Mali: a qualitative study