Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries
Objectives Haemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of oxytocin, before and after applying Salud Mesoaméri...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-03-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/3/e034084.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846139054445297664 |
|---|---|
| author | Ali H Mokdad Aruna M Kamath Alexandra M Schaefer Erin B Palmisano Casey K Johanns Alvaro Gonzalez Marmol Mauricio Dinarte Mendoza Karla Schwarzbauer Paola Zúñiga-Brenes Diego Ríos-Zertuche Emma Iriarte Bernardo Hernandez Prado |
| author_facet | Ali H Mokdad Aruna M Kamath Alexandra M Schaefer Erin B Palmisano Casey K Johanns Alvaro Gonzalez Marmol Mauricio Dinarte Mendoza Karla Schwarzbauer Paola Zúñiga-Brenes Diego Ríos-Zertuche Emma Iriarte Bernardo Hernandez Prado |
| author_sort | Ali H Mokdad |
| collection | DOAJ |
| description | Objectives Haemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of oxytocin, before and after applying Salud Mesoamérica Initiative interventions in the poorest health facilities across Central America.Design Pre-post study.Setting 166 basic-level and comprehensive-level health facilities in Belize, Guatemala, Honduras, Mexico, Nicaragua and Panama.Participants A random sample of medical records for uncomplicated full-term deliveries (n=2470) per International Classification of Diseases coding at baseline (July 2011 to August 2013) and at first-phase follow-up (January 2014 to October 2014).Interventions A year of intervention implementation prior to first-phase follow-up data collection focused on improving access to oxytocin by strengthening supply chains, procurement, storage practices and pharmacy inventory monitoring, using a results-based financing model.Primary and secondary outcome measures Oxytocin availability (primary outcome) and administration (secondary outcome) for postpartum haemorrhage prevention.Results Availability of oxytocin increased from 82.9% to 97.6%. Oxytocin administration increased from 83.6% to 88.4%. Significant improvements were seen for availability of oxytocin (adjusted OR (aOR)=8.41, 95% CI 1.50 to 47.30). Administration of oxytocin was found to be significantly higher in Honduras (aOR=2.96; 95% CI 1.00 to 8.76) in reference to Guatemala at follow-up.Conclusion After interventions to increase health facility supplies, the study showed a significant improvement in availability but not administration of oxytocin in poor communities within Mesoamerica. Efforts are needed to improve the use of oxytocin. |
| format | Article |
| id | doaj-art-90f96a554fce4b46be093e3662837fc7 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-90f96a554fce4b46be093e3662837fc72024-12-06T13:00:09ZengBMJ Publishing GroupBMJ Open2044-60552020-03-0110310.1136/bmjopen-2019-034084Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countriesAli H Mokdad0Aruna M Kamath1Alexandra M Schaefer2Erin B Palmisano3Casey K Johanns4Alvaro Gonzalez Marmol5Mauricio Dinarte Mendoza6Karla Schwarzbauer7Paola Zúñiga-Brenes8Diego Ríos-Zertuche9Emma Iriarte10Bernardo Hernandez Prado11Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USADepartment of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USADepartment of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USADepartment of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USADepartment of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USASalud Mesoamerica Initiative, Inter-American Development Bank, Panama City, PanamaSalud Mesoamerica Initiative, Inter-American Development Bank, Panama City, PanamaSalud Mesoamerica Initiative, Inter-American Development Bank, Tegucigalpa, HondurasSalud Mesoamerica Initiative, Inter-American Development Bank, San José, Costa RicaSalud Mesoamerica Initiative, Inter-American Development Bank, Washington, DC, USA3 Inter-American Development Bank, Washington, District of Columbia, USADepartment of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USAObjectives Haemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of oxytocin, before and after applying Salud Mesoamérica Initiative interventions in the poorest health facilities across Central America.Design Pre-post study.Setting 166 basic-level and comprehensive-level health facilities in Belize, Guatemala, Honduras, Mexico, Nicaragua and Panama.Participants A random sample of medical records for uncomplicated full-term deliveries (n=2470) per International Classification of Diseases coding at baseline (July 2011 to August 2013) and at first-phase follow-up (January 2014 to October 2014).Interventions A year of intervention implementation prior to first-phase follow-up data collection focused on improving access to oxytocin by strengthening supply chains, procurement, storage practices and pharmacy inventory monitoring, using a results-based financing model.Primary and secondary outcome measures Oxytocin availability (primary outcome) and administration (secondary outcome) for postpartum haemorrhage prevention.Results Availability of oxytocin increased from 82.9% to 97.6%. Oxytocin administration increased from 83.6% to 88.4%. Significant improvements were seen for availability of oxytocin (adjusted OR (aOR)=8.41, 95% CI 1.50 to 47.30). Administration of oxytocin was found to be significantly higher in Honduras (aOR=2.96; 95% CI 1.00 to 8.76) in reference to Guatemala at follow-up.Conclusion After interventions to increase health facility supplies, the study showed a significant improvement in availability but not administration of oxytocin in poor communities within Mesoamerica. Efforts are needed to improve the use of oxytocin.https://bmjopen.bmj.com/content/10/3/e034084.full |
| spellingShingle | Ali H Mokdad Aruna M Kamath Alexandra M Schaefer Erin B Palmisano Casey K Johanns Alvaro Gonzalez Marmol Mauricio Dinarte Mendoza Karla Schwarzbauer Paola Zúñiga-Brenes Diego Ríos-Zertuche Emma Iriarte Bernardo Hernandez Prado Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries BMJ Open |
| title | Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries |
| title_full | Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries |
| title_fullStr | Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries |
| title_full_unstemmed | Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries |
| title_short | Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries |
| title_sort | access and use of oxytocin for postpartum haemorrhage prevention a pre post study targeting the poorest in six mesoamerican countries |
| url | https://bmjopen.bmj.com/content/10/3/e034084.full |
| work_keys_str_mv | AT alihmokdad accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT arunamkamath accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT alexandramschaefer accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT erinbpalmisano accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT caseykjohanns accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT alvarogonzalezmarmol accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT mauriciodinartemendoza accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT karlaschwarzbauer accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT paolazunigabrenes accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT diegorioszertuche accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT emmairiarte accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries AT bernardohernandezprado accessanduseofoxytocinforpostpartumhaemorrhagepreventionaprepoststudytargetingthepoorestinsixmesoamericancountries |