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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effect on Postpartum Hemorrhage of Prophylactic Oxytocin (10 IU) by Injection by Community Health Officers in Ghana: A Community-Based, Cluster-Randomized Trial
PLoS Medicine, Volume 10, No. 10, Article e1001524, Year 2013
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Description
Background:Oxytocin (10 IU) is the drug of choice for prevention of postpartum hemorrhage (PPH). Its use has generally been restricted to medically trained staff in health facilities. We assessed the effectiveness, safety, and feasibility of PPH prevention using oxytocin injected by peripheral health care providers without midwifery skills at home births.Methods and Findings:This community-based, cluster-randomized trial was conducted in four rural districts in Ghana. We randomly allocated 54 community health officers (stratified on district and catchment area distance to a health facility: ≥10 km versus <10 km) to intervention (one injection of oxytocin [10 IU] one minute after birth) and control (no provision of prophylactic oxytocin) arms. Births attended by a community health officer constituted a cluster. Our primary outcome was PPH, using multiple definitions; (PPH-1) blood loss ≥500 mL; (PPH-2) PPH-1 plus women who received early treatment for PPH; and (PPH-3) PPH-2 plus any other women referred to hospital for postpartum bleeding. Unsafe practice is defined as oxytocin use before delivery of the baby. We enrolled 689 and 897 women, respectively, into oxytocin and control arms of the trial from April 2011 to November 2012. In oxytocin and control arms, respectively, PPH-1 rates were 2.6% versus 5.5% (RR: 0.49; 95% CI: 0.27-0.88); PPH-2 rates were 3.8% versus 10.8% (RR: 0.35; 95% CI: 0.18-0.63), and PPH-3 rates were similar to those of PPH-2. Compared to women in control clusters, those in the intervention clusters lost 45.1 mL (17.7-72.6) less blood. There were no cases of oxytocin use before delivery of the baby and no major adverse events requiring notification of the institutional review boards. Limitations include an unblinded trial and imbalanced numbers of participants, favoring controls.Conclusion:Maternal health care planners can consider adapting this model to extend the use of oxytocin into peripheral settings including, in some contexts, home births.Trial registration:ClinicalTrials.gov NCT01108289 Please see later in the article for the Editors' Summary. © 2013 Stanton et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3794862/bin/pmed.1001524.s001.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3794862/bin/pmed.1001524.s002.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3794862/bin/pmed.1001524.s003.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC3794862/bin/pmed.1001524.s004.docx
Authors & Co-Authors
Stanton, Cynthia K.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Newton, Sam Kofi Tekyi
Ghana, Kintampo
Kintampo Health Research Centre
Mullany, Luke C.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Cofie, Patience Korkor
Ghana, Accra
Path
Tawiah-Agyemang, Charlotte A.
Ghana, Kintampo
Kintampo Health Research Centre
Adiibokah, Edward
Ghana, Kintampo
Kintampo Health Research Centre
Amenga-Etego, Stephen D.
Ghana, Kintampo
Kintampo Health Research Centre
Darcy, Niamh
United States, Research Triangle Park
Rti International
Khan, Sadaf
United States, Seattle
Path Seattle
Armbruster, Deborah
United States, Washington, D.c.
United States Agency for International Development
Gyapong, John O.
Ghana, Accra
University of Ghana
Owusu-Agyei, Seth
Ghana, Kintampo
Kintampo Health Research Centre
Statistics
Citations: 40
Authors: 12
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pmed.1001524
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Study Locations
Ghana
Participants Gender
Female