C002D5556 Sunday 04 March 2018 46BDSUNDAY Health&Science Life and Death: Why maintaining Oxytocin quality standards can save women’s lives during childbirth Every millennium has had unique challenges, and some challenges have carried on from one millennia to another. One of such challenges is maternal mortality. For centuries, death has been feared as one of the possible dangers to a woman while giving birth. Although the annual maternal mortality rate has reduced by about 43% from 1990 to 2015 worldwide, this has hardly reflected on the maternal mortality rates in Nigeria. Everyday in 2015, approximately 830 women died from preventable causes related to pregnancy and childbirth. 19% of maternal deaths worldwide in 2015 were in Nigeria. Maternal mortality is caused by many factors; from eclampsia to prolonged labour to infections. However, Post-Partum Haemorrhage (PPH), defined as loss of more than 500ml of blood from the vagina immediately after labour or within 24 hours after delivery, is arguably the leading cause of maternal mortality in developing countries. Post-partum haemorrhage is caused by excessive bleeding as a result of the uterus being unable to contract efficiently, from vaginal or cervical tears. According to the World Health Organisation (WHO), PPH accounts for one quarter of all maternal deaths worldwide. Providing solutions to PPH, could lead to a reduction of about 30% in maternal deaths, quite a significant figure. Post-partum haemorrhage is both preventable and treatable. In its 2012 Guideline for the Prevention and Treatment of Post-Partum Haemorrhage, WHO recommended that all women giving birth should be given “uterotonics” which are medicines used to induce or increase the contraction of the uterus during delivery. Uterotonics include oxytocin, misoprostol and ergometrine. However, because of its proven efficacy and safety, it is recommended that oxytocin be given as the first line drug against postpartum haemorrhage. Oxytocin needs a stable cold chain from point of manufacture to point of use. These medications which easily prevent PPH are readily available and fairly affordable. Still, the frequency and fatality of postpartum haemorrhage in Nigeria is quite high. To investigate why deaths from PPH remain high in Nigeria, the US Pharmacopeial Convention (USP) in collaboration with the National Agency for Food and Drug Administration and Control (NAFDAC) carried out a survey in 2016 to determine the quality of oxytocin and related PPH drugs in various hospitals and clinics across the six geo-political zones of Nigeria. The survey found that about 74.2% of oxytocin samples in the country failed lab quality evaluations, and 33.7% of misoprostol tablets were found to be of sub-standard quality. This means that 3 out 4 oxytocin ampoules in Nigerian hospitals are of sub-standard quality. In other words, the likelihood that only about a quarter of oxytocin doses administered in Nigeria will have met the required quality standards. Alongside other prevailing factors, this could help explain why Nigeria still has an unreasonably high rate of maternal deaths due to complications from pregnancy and childbirth. Reducing the circulation and use of sub-standard uterotonics, especially oxytocin injections, may contribute significantly to the reduction of maternal deaths in Nigeria. But before that step, we must first understand why there is such a high failure rate of such an otherwise potent drug in Nigeria, and few questions needed to be addressed. Are oxytocin injections not manufactured properly by the pharmaceutical companies? Is the active ingredient added to the drug not the right amount? Are there problems with the importation and transport systems? Are there issues with the storage systems for oxytocin? Are oxytocin injections administered at the recommended dose by healthcare providers? In a follow up to the survey, the United States Agency for International Development (USAID) – funded “Promoting the Quality of Medicine (PQM)” project, implemented by the U.S Pharmacopeial (USP) Convention, commissioned a team of researchers, led by Dr. Chioma Ejekam of the Department of Community Health, Lagos University Teaching Hospital (LUTH) to examine clinical experiences with regards to the use of oxytocin injections by healthcare providers in Lagos State. The results of this research were presented in Lagos at a roundtable discussion with the theme “Dissemination of the Clinical Experiences of Oxytocin Quality used by Healthcare Providers in Lagos State” on 20th February, 2018 . The commissioned research revealed the following: Firstly, 41% of healthcare providers in Lagos State have used an oxytocin dose that was higher than the World Health Organisation (WHO) recommendation. Secondly, just over 64% admitted that they had no way of reporting the perceived ineffectiveness of the drug and thirdly, about 13% of the 705 healthcare providers from public and private health facilities who were interviewed, have at one time or another come across an ineffective brand of oxytocin. The most striking of the findings however, was that only 52% of the respondents knew the proper storage procedures for oxytocin, which is supposed to be stored between 2 –8°Celcius. Ejekam pointed out during an interview with Nigeria Health Watch that, “If these skilled health workers do not know the proper storage of oxytocin, imagine what the knowledge of the lower cadre health workers would be.” Renowned Professor of Obstetrics and Gynaecology, Frank Giwa-Osagie,a professor, stressed the need for regulatory agencies to increase their post-marketing surveillance of medications across the country and the enforcement of standard regulatory procedures for the storage of medications in hospitals and pharmacies. The fact that 52% of healthcare workers interviewed did not know the proper storage conditions for oxytocin and 41% have administered oxytocin at a dose higher than WHO recommended guidelines is a serious cause for concern. While efforts are made to improve the overall supply chain system, storage procedures and administration of oxytocin injections, it could be helpful to also pay more attention to misoprostol, an alternative drug recommended by the WHO and International Federation of Gynecology and Obstetrics (FIGO) for the management of PPH. Because misoprostol is administered orally, it does not require administration by a skilled healthcare professional, and it can be stored at room temperature without losing its efficacy. These factors mean that misoprostol has less of a failure rate than oxytocin in Nigeria. As Akinola, a professor and current President of the Society of Gynaecology & Obstetrics of Nigeria (SOGON) mentioned during the Lagos USP meeting, there are a number of potential product options for the prevention and treatment of PPH, however they’re only useful if they’re good quality products. Chimezie Anyakora of U.S Pharmacopeia Convention mentioned that they plan to expand the Clinical Experience of the use of Oxytocin Survey to cover more states across the length and breadth of Nigeria, to unearth more significant findings that will help in reducing post-partum haemorrhage when oxytocin is administered in Nigeria. It could also be useful for the US Pharmacopeia Convention to include other uterotonics such as ergometrine and misoprostol in the Nationwide Clinical Experience Survey they intend to conduct on oxytocin. By understanding the experience of different healthcare providers from all regions of the Federation, we will have a more flexible and robust approach towards the use of specific medications for the prevention and management of PPH. These findings, though only from Lagos State, reveal the task ahead for Nigeria if it is to reduce maternal mortality through the proper use of oxytocin. All participants at the dissemination discussion agreed that there is an urgent need to revolutionize the Drug Supply Chain System in Nigeria. From challenges of standard procurement practices, to the arrival of the medications at the ports, to the vehicles conveying them to different locations across the country, to the pharmacies and hospitals where these drugs are stored before use, care must be taken to ensure that the right storage conditions are maintained for this vital drug to ultimately save Nigerian women from dying from complications after childbirth. - Nigeria HealthWatch
Sunday 04 March 2018 C002D5556 BDSUNDAY 47 Sports Baru says sports a veritable tool for productivity, service delivery Anthony Nlebem Group Managing Director of the Nigerian National Petroleum Corporation (NNPC), Dr. Maikanti Baru has charged Oil and Gas workers across the country to work assiduously towards proffering viable solutions to the industry’s numerous challenges. Dr. Baru, who made the call during the closing ceremony of the 17th edition of the Nigerian Oil & Gas Industry Games (NOGIG 2018) held at the Teslim Balogun Stadium in Lagos, on Saturday also called upon the oil workers to get involved in sporting activities towards improving their productivity and service delivery. “Without doubt, there are lots of advantages in getting involved in sports. People who participate in sports exhibit quality lifestyle both at home and in the workplace. Since they are more active, their brains proffer some of the most efficient and viable solutions to the challenges of the Industry today,” Dr. Baru stated. According to the GMD, a number of ailments are attributable to inactivity characterized by lack of exercise and a care-free lifestyle among people. The GMD also tasked the Adamu Atta: Is the king of Polo quitting? After a deserved restoration procedure by the finest craftsmen in London, the gleaming Majekodunmi Cup was dramatically delivered by a Caverton helicopter to the Lagos polo club moments before the final match of the most coveted prize in Nigerian polo. But for the thousands of wowed spectators there would have been very little doubt in their minds where the silverware would end up after all: In the hands of star player and patron, Adamu Atta - and for a record fourth consecutive year at that. It is also Atta’s Fifth Chukker team’s 7th title in ten years, and his 11th since he first won the cup in 1998 with Team MIA-First Fuels, making him the most successful player and patron in the 55-year history of the trophy which was presented to the club in 1962 by the administrator of Western Region, Dr. M.A. Majekodunmi. participants to always make integrity and sportsmanship their watchword. “This is because at the end of it all, everyone of you here is considered a winner.” Congratulating the various sportsmen and women who participated at the biannual sporting showpiece, Dr. Baru called upon them to go back to their respective companies and unleash their potentials towards maximum productivity and effective service delivery for the benefit of the entire Oil and Gas Industry. He said NNPC remained committed to identifying with the lofty ideals of the games which he said were aimed not just at mere participation, but fostering unity and cordial relationships among the entire oil and gas workforce across the nation. He commended the Local Organising Committee for its tireless effort towards ensuring “not only a successful tournament but one that everyone in the industry is proud of” Earlier in her remarks, the Representative of the Minister of State for Petroleum Resources and the Director, Safety, Healthy & Environment at the Department of Petroleum Resources (DPR), Mrs. Onyebuchi Sibeudu described sports as a unifying force among people which should always be encouraged. Adamu Atta Dr. Maikanti Baru, GMD NNPC (2nd left) presents the Basketball Trophy to Enejoh Douglas, Ahmadu-Kida Musa, Total Deputy Managing Director (Deepwater District) (1st left); Aminu-Zaria Mohammed, Chairman NOGIG 2018 LOC, (2nd right) and Tony Attah, MD/CEO NLNG (1st right), during the closing ceremony of the 17th Nigerian Oil & Gas Industry Games (NOGIG 2018) held at the Teslim Balogun Stadium, Lagos, recently. She expressed satisfaction over the performance of the sportsmen and women, stressing that some of the talents on display today show that the Oil and Gas Industry has what it takes to take Nigeria to sporting stardom. Several other chief executive officers of the International Oil Companies (IOCs) operating in Nigeria spoke on the attraction for sports to forge lasting friendship and strategic partnerships amongst oil workers in the country. In addition to his rich Lagos pickings, Atta has also covered himself in glory with multiple wins of the nation’s other top high goal prizes, notably the Georgian cup in Kaduna which he won on eight occasions, as well as the championships at Keffi Ranch, Kano and Fifth Chukker amongst others. But the Kaduna-born legend’s exploits are transnational as well. With hundreds of horses, physical assets and personnel spread across four continents - in Argentina, South Africa, Nigeria, UK and Dubai - Atta has become a global polo icon and the indisputable king of African polo who is revered and feted the world over. After 25 very successful years dominating a very high octane, tough, physically challenging and financially draining sport like polo, word is seeping out that Atta may be seriously contemplating retirement. Nonetheless, a At the end of the week-long games, Shell Nigeria emerged the overall winners, clinching nine gold, 10 silver and eight bronze medals to cart home the 2018 trophy. NNPC placed second with eight gold, 10 silver and 13 bronze medals, while the third place went to Chevron, who amassed seven gold, two silver and five bronze medals. NLNG beat ExxonMobil to fourth place after winning five gold, five silver and five bronze medals with Exxon- Mobil, collecting two gold, five silver and six bronze medals. NAOC took sixth position with two gold, two silver and nine bronze. While Seplat and OVH Energy failed to appear on the medals table, Total, NCDMB, DPR, Eroton and PTI placed 7th, 8th, 9th, 10 and 11th respectively. The bi-annual tourney, which is the 17th in the series, featured 10 events namely: football, basketball, swimming, 8-ball pool, chess, scrabble, athletics, squash, lawn tennis and table tennis. cross-section of pundits believe that the tremendous goodwill, admiration and affection he commands in the polo community could keep him going a bit longer. Top polo writer Ernest Ekpenyong waxes that “Atta remains the most looked-upto person in Nigerian polo, his presence illuminates tournaments and confers them with instant class and credibility.” Beyond that, Atta and his fabulous Fifth Chukker polo and country club constitute the Gold standard for Nigerian polo. Aficionados readily acknowledge that he is the man with the Midas touch, always making it look easy. A firm believer that polo must give back to society, Atta has been supporting UNICEF and the Breast cancer awareness campaign for over a decade. The philanthropist is also ever willing to oblige other worthy causes. For instance, when he is not playing in Windsor at a UNICEF fundraiser alongside World No.1 Adolfo Cambiaso and La Dolfina (the greatest team of all time), Atta could be engaged in Cape Town teaming up with Prince Harry in a charity match to benefit the Lesotho Royal Sentabale Trust. At 50 and with an overflowing trophy cabinet, is Atta really contemplating retirement? Very dependable sources close to him say he is doing such and that it makes a lot of sense for him to start easing off. That may be so but several aficionados counter that the man is addicted to polo and cannot do any considerable time without the adrenaline fix of a competitive match. They maintain that for the multiple Patron of the Year award winner, polo will always remain an unfinished business because there is always that one more pony to buy, one more team to put together, one more trophy to win.