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Abstract
Objective This study assessed the potential operational feasibility and acceptability of a heat-stable, inhaled oxytocin (IOT) product for community-based prevention of postpartum haemorrhage in Myanmar.
Methods A qualitative inquiry was conducted between June 2015 and February 2016 through focus group discussions and in-depth interviews. Research was conducted in South Dagon township (urban setting) and in Ngape and Thanlyin townships (rural settings) in Myanmar. Eleven focus group discussions and 16 in-depth interviews were conducted with mothers, healthcare providers and other key informants. All audio recordings were transcribed verbatim in Myanmar language and were translated into English. Thematic content analysis was done using NVivo software.
Results Future introduction of an IOT product for community-based services was found to be acceptable among mothers and healthcare providers and would be feasible for use by lower cadres of healthcare providers, even in remote settings. Responses from healthcare providers and community members highlighted that midwives and volunteer auxiliary midwives would be key advocates for promoting community acceptance of the product. Healthcare providers perceived the ease of use and lack of dependence on cold storage as the main enablers for IOT compared with the current gold standard oxytocin injection. A single-use disposable device with clear pictorial instructions and a price that would be affordable by the poorest communities was suggested. Appropriate training was also said to be essential for the future induction of the product into community settings.
Conclusion In Myanmar, where home births are common, access to cold storage and skilled personnel who are able to deliver injectable oxytocin is limited. Among community members and healthcare providers, IOT was perceived to be an acceptable and feasible intervention for use by lower cadres of healthcare workers, and thus may be an alternative solution for the prevention of postpartum haemorrhage in community-based settings in the future.
- inhaled oxytocin
- postpartum haemorrhage
- community-based care
- task-shifting
- myanmar
- auxiliary midwives
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Footnotes
Contributors KKT contributed to study design, data collection, data analysis and led the first draft and finalisation of the manuscript. VO contributed to study design, data collection, data analysis and development of the manuscript. YM contributed to study design and data analysis and development of the manuscript. TL contributed to data collection and development of the manuscript. MM and PL contributed to study design and development of the manuscript. SL contributed to study design, data analysis and led the revisions of the manuscript. All authors read and approved the final manuscript.
Funding This study and report was made possible by the generous support of the Saving Lives at Birth partners: the United States Agency for International Development (USAID), the Government of Norway, the Bill and Melinda Gates Foundation, Grand Challenges Canada and the UK Government (grant number: AID-OAA-F-14-00046).
Disclaimer GlaxoSmithKline had no role in the funding, design or conduct of this study. The authors have no commercial interest in the outcomes of this study or the introduction of the inhaled oxytocin product in low and lower middle-income countries.
Competing interests We have read and understood BMJ policy on declaration of interests. VO, PL and MM are part of a product development team at Monash University, which is progressing the development of a heat stable oxytocin product for the prevention of PPH in resource-poor settings. MM is the coinventor of a worldwide patent application ‘Method and Formulation for Inhalation’ (WO 2013/016754) that covers the delivery of biologically active agents (including oxytocin) in the form of dry powders for inhalation. Inhaled oxytocin is being developed through a product development collaboration agreement between Monash University and GlaxoSmithKline. Authors declare no other conflict of interest.
Patient consent Not required.
Ethics approval Ethical clearance for the study was obtained from the Alfred Hospital Ethics Committee, Australia (Project 153/15), the Monash University Human Research Ethics Committee, Australia (CF15/1701 – 2015000854) and from the Ethical Review Committee on Medical Research Involving Human Subjects from the Department of Medical Research Myanmar (48/ Ethics 2015).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data generated and analysed for the current study are not publicly available as the qualitative study was collected from specific townships, and the information may be identifiable to particular individuals, risking a breach in confidentiality.