Unregulated usage of labour-inducing medication in a region of Pakistan with poor drug regulatory control: characteristics and risk patterns.
BACKGROUND
In developing countries such as Pakistan, poor training of mid-level cadres of health providers, combined with unregulated availability of labour-inducing medication can carry considerable risk for mother and child during labour. Here, we describe the exposure to labour-inducing medication and its possible risks in a vulnerable population in a conflict-affected region of Pakistan.


METHODS
A retrospective cohort study using programme data, compared the outcomes of obstetric risk groups of women treated with unregulated oxytocin, with those of women with regulated treatment.


RESULTS
Of the 6379 women included in the study, 607 (9.5%) received labour-inducing medication prior to reaching the hospital; of these, 528 (87.0%) received unregulated medication. Out of 528 labour-inducing medication administrators, 197 (37.3%) traditional birth attendants (also known as dai) and 157 (29.7%) lady health workers provided unregulated treatment most frequently. Women given unregulated medication who were diagnosed with obstructed/prolonged labour were at risk for uterine rupture (RR 4.1, 95% CI: 1.7-9.9) and severe birth asphyxia (RR 3.9, 95% CI: 2.5-6.1), and those with antepartum haemorrhage were at risk for stillbirth (RR 1.8, 95% CI: 1.0-3.1).


CONCLUSIONS
In a conflict-affected region of Pakistan, exposure to unregulated treatment with labour-inducing medication is common, and carries great risk for mother and child. Tighter regulatory control of labour-inducing drugs is needed, and enhanced training of the mid-level cadres of healthcare workers is required.
Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Islamabad, Pakistan dr.safieh@gmail.com.
Safieh
S
Shah
Operational Research Unit (LuxOR), Médecins Sans Frontières - Operational Centre Brussels, Luxembourg, Luxembourg.
Rafael
R
Van den Bergh
Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
Jeanne Rene
JR
Prinsloo
Maternal Child Health Department, Médecins Sans Frontières - Operational Centre Brussels, Timurgara, Khyber Pakhtunkhwa, Pakistan.
Gulalai
G
Rehman
Maternal Child Health Department, Médecins Sans Frontières - Operational Centre Brussels, Timurgara, Khyber Pakhtunkhwa, Pakistan.
Amna
A
Bibi
Maternal Child Health Department, Médecins Sans Frontières - Operational Centre Brussels, Timurgara, Khyber Pakhtunkhwa, Pakistan.
Neelam
N
Shaeen
Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Islamabad, Pakistan.
Rosa
R
Auat
Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
Sabina Mutindi
SM
Daudi
Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
Joyce Wanjiru
JW
Njenga
Pakistan Ministry of Health (MoH), District Headquarter Hospital, Timurgara, Khyber Pakhtunkhwa, Pakistan.
Tahir Bashir-Ud-Din
TB
Khilji
Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
Jacob
J
Maïkéré
Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
Eva
E
De Plecker
Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
Séverine
S
Caluwaerts
Operational Research Unit (LuxOR), Médecins Sans Frontières - Operational Centre Brussels, Luxembourg, Luxembourg.
Rony
R
Zachariah
Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
Catherine
C
Van Overloop
D000328:Adult; D004335:Drug and Narcotic Control; D005260:Female; D006282:Health Personnel; D006801:Humans; D057970:Inappropriate Prescribing; D000068104:Infant Health; D000068097:Maternal Health; D010120:Oxytocics / Q000008:administration & dosage*; D010154:Pakistan; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012306:Risk
D010120:Oxytocics
Labour induction; Maternal child health; Obstetrics; Operational research; Oxytocin; Pakistan