By Catherine Mwesigwa Kizza
Ugandan obstetricians and gynaecologists are recommending the self-administration of Misoprostol , a tablet that can prevent excessive bleeding after childbirth, by mothers who are unable to deliver in health facilities.
Meeting at their annual scientific conference in Kampala last week, they observed that the pace of reduction of maternal deaths in Uganda is very slow and requires innovative approches to accelerate it.
World over, excessive bleeding (post partum heamhorrhage) after childbirth is the leading cause of maternal death. In Uganda, it accounts for 26% of the over 6,000 maternal deaths annually.
This is despite the fact that drugs to prevent it are available.
The most available drugs (oxytocin and ergometrin) are injectables and therefore can only be administered by skilled attendants (health workers with midwifery training) in functioning health facilities.
Ergometrin, the most popular in Ugandan health facilities also particularly needs refrigeration to stay stable and is therefore not feasible for rural facilities with no refrigeration capacity.
But despite over ten years of campaigns to encourage mothers to attend at least four antenatal care visits during pregnancy and deliver with skilled attendants, their reponse has been slow. Yet every pregnant women is at risk of excessive bleeding after birth.
“Sixty per cent of women who cannot access delivery services can be saved by the use of Misoprostol,” Dr. Charles Kiggundu, a senior consultant gynaecologist said.
“We cannot continue to let women die when we have the solutions. The hinderance to using scientifically proven drugs is with health workers not the women,” he added.
Professor Florence Mirembe, a senior consultant obstetrician and gynaecologist who has been practicing in Uganda for more than 40years also noted that as long as there is evidence that the tablet can be used there is no need to worry.
“We just need guidelines otherwise we wouldn’t have any drugs. Look at Aspirin, people misuse it but it is available for them. What about bicycle spokes? Women are misusing them to perform abortions but they were never meant for that. Let’s get the proper guidelines and use the drug to prevent mothers from dying,” she said.
The recommendation comes after three researches in Uganda involving over 12,000 women using the tablets on their own were successful. Misopostol was registered for use in Uganda in 2008 but by skilled health workers.
Some health workers are reluctant to recommend opening up of Misoprostol because apart from preventing post partum heamorrhage, it can also treat peptic ulcers and induce abortions. They fear that the drug will be abused.
However, presenting research findings at the meeting, Dr Sam Ononge said that excessive bleeding after childbirth happened in only 3.3% of women who were in the research group taking the drug as compared to 24% among women who were in the group that was not taking it.
The research was carried out by different groups. One was in Kasese and Nebbi , the second study was in Mubende and Mityana and the third in Mbale. All studies were carried out between October 2010 and 2012.
The studies all together involved 12,617 pregnant rural women and found that they were largely able to use the drug without medical supervision to prevent excessive bleeding after delivery.
Only two women in Mbale mistimed and took the drug at the unprescribed time. One took it before delivery and she delivered after two days, one took it during labour and nothing happened.
The researchers observed other benefits. In Mbale 58% of the women delivered in hospital while in Mubende, hospital deliveries increased to 70%. The women found the drug acceptable.
The only side effects reported were fever and chills.
Dr Ononge said that these findings have already been given to Ministry of Health.
“There is need to revise the guidelines of using the drug because they are currently limiting it to trained health workers,” he said.
World Health Organisation recommended the use of Misoprostol by lay health workers where there is no skilled attendant.
This followed several studies with successful outcomes in Guinea-Bissau at the lowest level of the healthcare system, in Gambia by Traditional Birth Attendants and in India using axillary nurse midwives.
However, the organisation recommends further research on the impact where the drug is distributed during antenatal care for self-administration after delivery at home.