Nigeria Health Watch: Poor knowledge and practice around oxytocin could put women in Nigeria at risk during childbirth

20 February, 2022

Here is an article from the excellent team at Nigeria Health Watch. Below are the opening paragraphs. Read in full:


Severe bleeding after childbirth - postpartum haemorrhage - is a leading cause of maternal morbidity and mortality in middle-income countries. Oxytocin is an affordable and effective drug that’s recommended to prevent postpartum haemorrhage.

But there are concerns about the quality of oxytocin available for use by healthcare workers in most low- and middle-income countries, including Nigeria.

Oxytocin requires cold chain supply from the point of manufacture to the point of use for it to maintain its effectiveness. But most facilities in low- and middle-income countries, especially those at the primary healthcare level, have no refrigerators or reliable electricity supply.

A 2018 study looked into the quality of medicines for maternal health in Nigeria. It reported that 74% of oxytocin samples failed laboratory tests. This means there was a high prevalence of substandard oxytocin available in the country.

There is growing evidence that when poor-quality oxytocin is used, it fails to prevent post-partum haemorrhage. Poor-quality medicines may be an unaccounted root cause of high maternal mortality in low- and middle-income countries. But healthcare providers often do not suspect this. As a result, they do not document or discuss the poor quality of medicine.

Another concern is the apparent lack of adequate knowledge around oxytocin among healthcare providers. A pilot study in Lagos assessed the knowledge and use of oxytocin among 705 doctors and nurses. It found that only 52% of the respondents knew oxytocin should be stored at 2˚C to 8˚C - and 41% used double the recommmended dose. Only about 13% of respondents reported they had used an ineffective brand of oxytocin and of this, just 12% had the needed pharmacovigilance form in their health facilities to report the ineffectiveness.

We then expanded the Lagos study to get a broader picture. The national study selected 12 states and a sample of 6,299 healthcare workers (including doctors, nurses, midwives and community health workers). The study assessed their knowledge, use, storage practices and perceived quality of oxytocin used for prevention of post-partum haemorrhage. We found significant gaps in knowledge of best practice and this could endanger the lives of women giving birth.

Our findings should be used to establish clinical guidelines and training. Healthcare providers need to improve their knowledge, storage practices and use to safeguard the quality of these lifesaving medicines...


Neil Pakenham-Walsh, HIFA Coordinator,