Postpartum Hemorrhage in Humanitarian Settings: Heat-Stable Carbetocin and Tranexamic Acid Implementation Study in Uganda

Tran, NT; Mugerwa, K; Muwanguzi, S; Mwesigwa, R; Wasswa, D; Zeck, W; Seuc, A; Schulte-Hillen, C

Postpartum Hemorrhage in Humanitarian Settings: Heat-Stable Carbetocin and Tranexamic Acid Implementation Study in Uganda

Tran, NT Mugerwa, K Muwanguzi, S Mwesigwa, R Wasswa, D Zeck, W Seuc, A Schulte-Hillen, C

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Publisher:: Scientific Scholar
Publication Type:: Journal Article
Citation:: International Journal of Maternal and Child Health and AIDS (IJMA), 13, pp. s46-s54

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Field	Value	Language
dc.contributor.author	Tran, NT
dc.contributor.author	Mugerwa, K
dc.contributor.author	Muwanguzi, S
dc.contributor.author	Mwesigwa, R
dc.contributor.author	Wasswa, D
dc.contributor.author	Zeck, W
dc.contributor.author	Seuc, A
dc.contributor.author	Schulte-Hillen, C
dc.date.accessioned	2024-12-16T04:54:55Z
dc.date.available	2024-12-16T04:54:55Z
dc.identifier.citation	International Journal of Maternal and Child Health and AIDS (IJMA), 13, pp. s46-s54
dc.identifier.issn	2161-8674
dc.identifier.issn	2161-864X
dc.identifier.uri	http://hdl.handle.net/10453/182577
dc.description.abstract	<jats:sec> <jats:title>Background and Objective</jats:title> <jats:p>Postpartum hemorrhage (PPH) remains a major concern in crisis-affected settings. There is a lack of strategies for implementing heat-stable carbetocin (HSC) and tranexamic acid (TXA) in humanitarian settings. This study aims to investigate the impact of a capacity-strengthening package on the utilization of uterotonics for PPH prevention, PPH detection, and utilization of TXA for PPH treatment in basic obstetric care clinics in humanitarian settings in Uganda.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A multi-stepped implementation research study was conducted, wherein six select facilities utilized an intervention package encompassing provider training, an online community of practice, and wall-displayed PPH algorithms. Facilities were conveniently assigned to the same study sequence: T1 (routine care), a transition period for training; T2 (package without HSC and TXA); T3 (package with HSC); and T4 (package with HSC and TXA). The primary outcomes assessed trends in prophylactic uterotonic use (including HSC), visual diagnosis of hemorrhage, and HSC and TXA use for hemorrhage treatment. Analysis followed an intention-to-treat approach, adjusting for cluster effect and baseline characteristics. Pan-African Clinical Trials Registry: PACTR202302476608339.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>From April 10, 2022, to April 4, 2023, 2299 women were recruited (T1: 643, T2: 570, T3: 580, T4: 506). Over 99% of all women received prophylactic uterotonics across the four phases, with oxytocin alone primarily used in T1 (93%) and T2 (92%) and HSC alone in T3 (74%) and T4 (54%) (T4–T1 95% CI: 47.8–61.0). Hemorrhage diagnosis ranged from 1% to 4%. For hemorrhage treatment, universal oxytocin use in T1 and T2 decreased in T3 and T4 after HSC introduction (T4–T1: 33%–100%; 95% CI: –100.0 to –30.9), and TXA use increased in T4 (T4–T1: 33%–0%; 95% CI: –2.4 to 69.1).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion and Global Health Implications</jats:title> <jats:p>An intervention package to reinforce providers’ capacity to prevent and treat PPH can result in substantial HSC utilization and a moderate TXA adoption in cold-chain-challenged humanitarian settings. It could be scaled up with continuous capacity development and supportive supervision to mitigate confusion between existing and new medications, such as the decreased use of oxytocin for PPH treatment. Maintaining investments in cold-chain strengthening remains critical to ensure the quality of oxytocin.</jats:p> </jats:sec>
dc.language	en
dc.publisher	Scientific Scholar
dc.relation.ispartof	International Journal of Maternal and Child Health and AIDS (IJMA)
dc.relation.isbasedon	10.25259/ijma_9_2023
dc.rights	info:eu-repo/semantics/openAccess
dc.title	Postpartum Hemorrhage in Humanitarian Settings: Heat-Stable Carbetocin and Tranexamic Acid Implementation Study in Uganda
dc.type	Journal Article
utslib.citation.volume	13
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/School of Public Health
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/
dc.date.updated	2024-12-16T04:54:54Z
pubs.publication-status	Published online
pubs.volume	13

Abstract:

Background and Objective Postpartum hemorrhage (PPH) remains a major concern in crisis-affected settings. There is a lack of strategies for implementing heat-stable carbetocin (HSC) and tranexamic acid (TXA) in humanitarian settings. This study aims to investigate the impact of a capacity-strengthening package on the utilization of uterotonics for PPH prevention, PPH detection, and utilization of TXA for PPH treatment in basic obstetric care clinics in humanitarian settings in Uganda. Methods A multi-stepped implementation research study was conducted, wherein six select facilities utilized an intervention package encompassing provider training, an online community of practice, and wall-displayed PPH algorithms. Facilities were conveniently assigned to the same study sequence: T1 (routine care), a transition period for training; T2 (package without HSC and TXA); T3 (package with HSC); and T4 (package with HSC and TXA). The primary outcomes assessed trends in prophylactic uterotonic use (including HSC), visual diagnosis of hemorrhage, and HSC and TXA use for hemorrhage treatment. Analysis followed an intention-to-treat approach, adjusting for cluster effect and baseline characteristics. Pan-African Clinical Trials Registry: PACTR202302476608339. Results From April 10, 2022, to April 4, 2023, 2299 women were recruited (T1: 643, T2: 570, T3: 580, T4: 506). Over 99% of all women received prophylactic uterotonics across the four phases, with oxytocin alone primarily used in T1 (93%) and T2 (92%) and HSC alone in T3 (74%) and T4 (54%) (T4–T1 95% CI: 47.8–61.0). Hemorrhage diagnosis ranged from 1% to 4%. For hemorrhage treatment, universal oxytocin use in T1 and T2 decreased in T3 and T4 after HSC introduction (T4–T1: 33%–100%; 95% CI: –100.0 to –30.9), and TXA use increased in T4 (T4–T1: 33%–0%; 95% CI: –2.4 to 69.1). Conclusion and Global Health Implications An intervention package to reinforce providers’ capacity to prevent and treat PPH can result in substantial HSC utilization and a moderate TXA adoption in cold-chain-challenged humanitarian settings. It could be scaled up with continuous capacity development and supportive supervision to mitigate confusion between existing and new medications, such as the decreased use of oxytocin for PPH treatment. Maintaining investments in cold-chain strengthening remains critical to ensure the quality of oxytocin.

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http://hdl.handle.net/10453/182577