Accra, Feb. 21, GNA - A call has gone out for regular education for health workers on the appropriate use of uterotonics during and immediately after labour to reduce maternal deaths. Health workers who attended a workshop on the use of uterotonic substances argued that research findings had indicated that some midwives were misusing oxytocine and they needed to regulate its use to reduce maternal mortality.

Speaking at a day's dissemination meeting on Monday on a research conducted on the use of uterotonic substances at or around births, participants said regular supervision and monitoring should be conducted on its use by health workers at the facility level.

The research was conducted in the Yendi, Kintampo and Ahanta West districts by the Ghana Health Service in collaboration with Path Oxytocin Initiative Project and funded by the Bill and Melinda Gates Foundation. Ghana and India were selected for the research on the basis that Ghana had no evidence of inappropriate use of uterotonics at home births whilst India had had home-based use of uterotonic drugs.

The research was also to compile current policies, practices, perceptions and quality of uterotonic drugs and their use at birth. A uterotonic is an agent used to induce contraction or greater tonicit= y of the uterus. Utertonics are used both to induce labour and reduce Post-Partum Hemorrhage (PPH), which is the loss of greater than 500 ml of blood following vaginal delivery, or 1000 ml of blood following caesarean section.

PPH is the most common cause of perinatal maternal death in the developed world and is a major cause of maternal morbidity worldwide. Participants, who were members of the Technical Advisory Group, development partners, professional and regulatory bodies as well as the research institutions in health, said there was the need to also encourage women to use health facilities where pharmaceutical uterotonics were used instead of using traditional uterotonics, whose efficacy and potency could not be guaranteed. It was realized that uterotonics needed to be stored in a cold place a= t a required temperature but the research found out that the substances were stored on the shelves of the chemical stores visited. They therefore called for the Ministry of Health to go through the proper procurement processes and if possible contract UNICEF for a cold chain to ensure its proper storage.

The research discovered that the uterotonic substance, which should be sold by only the pharmacies, were being sold by chemical sellers and that could affect the potency and efficacy levels since its proper storage could not be guaranteed.

It was also discovered that pregnant women, especially those in the Northern Region, used traditional substances in place of uterotonics. These traditional substances need to be researched into to know their potency. Mrs Patience Cofie, Research Coordinator of Programme for Appropriate Technology in Health (PATH), noted that PPH was a leading cause of maternal death and disability and many countries were making efforts to expand the use of uterotonic drugs for PPH's prevention in their communities. She said the research was to explore knowledge, perceptions, usage patterns and test quality of uterotonic drugs at or around birth in three districts in Ghana, ascertain provider knowledge of and attitudes toward uterotonic use during labour and delivery at the peripheral level. It was also to assess community knowledge of and attitudes towards uterotonic use during labour and delivery, assess the availability of pharmaceutical and traditional uterotonic drugs to the public and test the chemical potency of pharmaceutical uterotonic and the various types of uterotonic substances used during labour and delivery.

She explained that more than half of all maternal deaths occurred within 24 hours of delivery, most commonly from excessive blood loss and an estimated 40,000 women worldwide died each year from PPH. Mrs Cofie noted that the substances that were sampled in the districts under research and were sent to the Food and Drugs Board failed the drug test for chemical activity and attributed it to probably the poor storage. Ms Cindy Stanton, Programme Implementer of the Oxytcin Initiative Research, called for the need to address the issue of chemical sellers having access to uterotonic substances, the chemical testing of the drugs and the Ministry of Health ensuring that the purchase of the substances wer= e done appropriately.

Dr Sylvia Deganus, Medical Doctor In charge of the Tema General Hospital, who presided, reiterated the need to regulate the use of the uterotonic substances and re-train midwives and monitor their use.