Quality of oxytocin available in low- and middle-income countries: a systematic review of the literature.

BACKGROUND: Oxytocin is the drug of choice for preventing and treating postpartum haemorrhage, an important cause of maternal death. Oxytocin is widely available in low and middle-income countries (LMIC) but there are concerns about its quality. OBJECTIVE: To identify, critically appraise and synthesise the findings of studies on the quality of oxytocin available in LMIC. SEARCH STRATEGY: We searched seven electronic databases, without language restriction. SELECTION CRITERIA: Studies reporting results of tests to assess quality of oxytocin samples from LMIC. DATA COLLECTION AND ANALYSIS: Study selection, data extraction and quality assessment were performed in duplicate. Results are presented descriptively. MAIN RESULTS: The search identified 2611 unique citations; eight studies, assessing 559 samples from 15 different countries were included. Most samples were collected from facility level settings (n = 509) and from the private sector (n = 321). The median prevalence of oxytocin samples that failed quality tests was 45.6% (range 0-80%), mostly due to insufficient amounts of active pharmacological ingredient. Over one-third of the samples (n = 204) had low (<90%) oxytocin content indicating substandard medicine; two samples had no active ingredient, suggesting possible counterfeit drugs. The proportion of low fails was higher in samples collected in Africa than in Asia or Latin America (57.5% versus 22.3% versus 0%, respectively, P < 0.0001), in private than in public sectors (34.0% versus 25.3%, P = 0.032) and in facilities than in central distributors (37.9% versus 22.0%, P = 0.030). CONCLUSION: There is a high prevalence of poor-quality oxytocin samples in LMIC countries, mainly due to inadequate amounts of active ingredient. TWEETABLE ABSTRACT: Systematic review points to problems with quality of oxytocin samples from low- and middle-income countries.

Successful control of epidemic diphtheria in the states of the Former Union of Soviet Socialist Republics: lessons learned.

Epidemic diphtheria reemerged in the Russian Federation in 1990 and spread to all Newly Independent States (NIS) and Baltic States by the end of 1994. Factors contributing to the epidemic included increased susceptibility of both children and adults, socioeconomic instability, population movement, deteriorating health infrastructure, initial shortages of vaccine, and delays in implementing control measures. In 1995, aggressive control strategies were implemented, and since then, all affected countries have reported decreases of diphtheria; however, continued efforts by national health authorities and international assistance are still needed. The legacy of this epidemic includes a reexamination of the global diphtheria control strategy, new laboratory techniques for diphtheria diagnosis and analysis, and a model for future public health emergencies in the successful collaboration of multiple international partners. The reemergence of diphtheria warns of an immediate threat of other epidemics in the NIS and Baltic States and a longer-term potential for the reemergence of vaccine-preventable diseases elsewhere. Continued investment in improved vaccines, control strategies, training, and laboratory techniques is needed.

Analysis of patients admitted to the emergency unit of a university children's hospital in Turkey.

A retrospective analysis of the computerized data of patients admitted to our Emergency Unit Inpatient Service in 1991 was conducted to obtain data about age, sex, referred sources, admission period, monthly admission rates, diagnoses and eventual outcome. More than 47% of patients were younger than one year of age. The most common causes for hospital admission were infectious, respiratory and neurological diseases. The mean hospitalization period was 3.26 days. More than 60% of patients were treated by the Emergency Unit staff. The net mortality rate was 2.9%, infectious diseases being the most common cause of mortality. We conclude that demographic and diagnostic data regarding admissions to the Emergency Unit can be utilized to develop new strategies for patient care and to reorganize education programs for pediatric residents.

The impact of systematic use of oral rehydration therapy on outcome in acute diarrheal disease in children.

A review of our experience with diarrheal disease (DD) at the University of Istanbul Children's Hospital in Capa, covering the years 1987 to 1989, is presented in this paper. DD is one of the most common conditions encountered among patients presenting to the outpatient clinic (5.9% of all cases). The majority of DD cases were in the four- to 12-month age group. During the surveillance period, summertime peaks in DD were observed, suggesting an increase in bacterial infection. Out of 8749 cases of DD, 5.2% showed severe dehydration. Rates of hospitalization for DD did not show any differences over the three years. However, mortality from DD significantly decreased from 1.15 to 0.57% during this three-year period. This was attributed to more rational use of oral rehydration solutions, as a result of the close monitoring and recording of findings introduced by the protocol of this study. Malnutrition, sepsis, pneumonia, and other severe systemic diseases were found to be the most important risk factors affecting hospitalization and mortality rates. Infants, especially those under three months, had the highest risk for hospitalization and mortality.