Indrayani, Sandra Harianis, Haryati Astuti, Rosmaria 1744 P J M H S Vol. 12, NO. 4, OCT – DEC 2018 How is oxytocin cold chain in peripheral areas? And is it still effective uterotonic? INDRAYANI 1 , SANDRA HARIANIS 2 , HARYATI ASTUTI 2 , ROSMARIA 3 ABSTRACT Background. World Health Organization (WHO) has recommended oxytocin as an optional uterotonic medicine to prevent and handle postpartum haemorrhage. However, there is much worry about the quality of oxytocin in developing countries. Aim: To describe the condition of oxytocin cold chain in the peripheral area, from the source until before being applied to the patients. Method. Mixed method with sequential exploratory strategy was used in this study. Qualitative design used phenomenological approach and quantitative method used cross-sectional approach. Data collecting was done through in-depth interviews using interview guidelines. Participants were oxytocin suppliers, persons in charge of drug warehouses in medical centres, and medical personnels helping childbirth. Samples were selected using purposive sampling. Data collecting was done from November 2017 to February 2018 in Indragiri Hilir Regency, the Province of Riau, Indonesia. There were 32 participants getting involved in in-depth interviews, 123 respondents filled in questionaires and all were verified using supporting data. Results. Findings of this study describe oxytocin cold chain including drugstores, delivery process, duration of delivery, oxytocin handling, oxytocin orders, kinds of medicine, medicine chests, and electricity in medicine supliers, drug warehouses and medical centres. Conclusion. Most of the cold chain of oxytocin is not maintained from drug suppliers, drug warehouses, health care providers to the patients. Deviation tolerance of oxytocin cold chain can not be used as a justification. There is a consequence of oxytocin potential decline for every deviation. The government should examine unregistered and below standard medicine manufacturers, and encourage law enforcement for every violation. Keywords: Cold chain, oxytocin, delivery, storage INTRODUCTION Up to now, the world’s attention is still focusing on postpartum haemorrhage as the main cause of mother’s mortality, particularly in developing countries 1 . Postpartum haemorrhage is defined as loss of blood >500 mL in the first 24 hours after giving birth and loss of blood >1000mL as severe postpartum haemorrhage in the same period of time 2 . The most common cause of haemorrhage is uterine atonia 3 . Some findings prove that the use of uterotonic prophylaxis in active management of third stage of labour with proper time and management can reduce the risk of postpartum haemorrhage 2, 4, 5 . World Health Organization (WHO) has recommended oxytocin as an optional uterotonic medicine that can be used routinely in active management of third stage of labour 2, 6 and considered it a golden standard 2 to prevent and handle postpartum haemorrhage 2, 7 . Besides, oxytocin has also been put in the list of WHO essential medicine model since it was firstly published in 1997 8-10 . Oxytocin is a peptide 11 which has a thermolabile characteristic 12-14 available in the form of solution kept in ampuls and it needs cold chain of storage, sterile needles with a special waste bin, and professional health personnels 15 . In order to maintain the effectiveness of ----------------------------------------------------------------------------------------- 1 Akademi Kebidanan Bina Husada, Tangerang 2 Akademi Kebidanan Husada Gemilang, Tembilahan 3 Politeknik Kesehatan, Kementrian Kesehatan Jambi Jurusan Kebidanan, Jambi Correspondence to Indrayani, Akademi Kebidanan Bina Husada, Tangerang. Kutai Raya No.1, Bencongan Kelapa Dua, Tangerang, Banten, Indonesia. Zip Code 15811 Ph. +6221-55655372 Fax. +6221-55655372. Email: indrayani_akbid@yahoo.co.id medicine, International Pharmacopoeia recommends the storage of oxytocin in temperature of 2-8 o C, and suggests to protect it from sun exposure 12, 16 and to avoid the risk of being frozen during storage because it can make the medicine unstable 17 . To prevent bleeding, oxytocin must be applied as soon as possible after childbirth 2, 4 . International Confederation of Midwives (ICM) and International Federation of Gynaecology and Obstetrics (FIGO) recommend to administer oxytocin in 1 minute after childbirth 18 . Therefore, skillful health personnels and safe practice of injection are crucial points, as well as the availability of proper cooler chests for oxytocin storage to maintain the stability of the medicine 7 . Health personnel’s skill is not optimum to reduce the risk of mortality, which is caused by bleeding, if it is not supported by high quality medicine. Nowadays, oxytocin has become one of three uterotonic medicines which are most frequently used in countries with low and medium income per capita 10 . However, there is much worry about the quality of oxytocin in such countries. The main worry related to the use of oxytocin is inconsistent and unreliable cold storage 6 and low quality of manufacture or improper transportation and storage. Oxytocin without cold storage will get damaged, especially in tropical climate 6 . This study aims to describe the condition of oxytocin cold chain in the peripheral area, from the source until before being applied to the patients. Findings of the study are expected to become feedbacks for the government and health personnels in order to improve the efective use of oxytocin as an optional uterotonic medicine to prevent and handle postpartum haemorrhage and as an effort to improve the quality of health service for the society.