'Nearly all maternal deaths occur in developing world'

HEALTH | MATERNITY

BRUSSELS - Globally, maternal mortality has dropped by about 43% since 1990. However, in 2015 alone, 303, 000 women still died due to complications of pregnancy and child birth.

Of these, 99% deaths happened in developing countries. Yet, most of them would have been prevented.

Maternal health experts are gathered in the Belgian capital Brussels for the 18th General Membership Meeting on Reproductive Health Supplies Coalition (RHSC).

The group identified haemorrhage and hypertension disorders as the two major direct causes of global maternal death.

Brian McKenna, the deputy director of RHSC, said there is urgent need to reduce global maternal mortality to less than 70 per 100, 000 live births by 2020, as by the sustainable development goals (SDGs).

He said access to quality medicine, better infrastructure and adequate personnel with go a long way in preventing women from dying while pregnant or giving birth.

"Any delay in the system and lack of essential drugs of reproductive health can lead to the death of a woman," he said.

In sub-Saharan Africa, the World Bank places Uganda fourth after Tanzania, Kenya and Nigeria in the nations with the highest maternal death rates.

Per 100,000 births, the top countries register as thus:

Nigeria   - 821

Kenya     - 540

Tanzania - 438

Uganda    - 372

Fiona Theunissen, the programme manager in charge of maternal health at Concept Foundation, said maternal mortality also affects a woman's family that suffers extremely following her death.

"A child whose mother dies in childbirth is three to 10 times more likely to die before his or her second birthday," she said.

She said postpartum haemorrhage accounted for 36·9% of deaths in northern Africa, but only 16·3% in developed regions.

Brian McKenna making a presentation in Brussels. (Credit: Hope Mafaranga)

Postpartum haemorrhage is severe bleeding experienced by women following the birth of a baby.

Milka Dinev, the RHSC regional advisor, said postpartum haemorrhage is preventable through the administration of an effective uterotonic to the mother immediately after the birth of her baby.

She explained that uterotonic medicines that cause the uterus to contract include oxytocin, misoprostol, ergometrine, syntometrine and carbetocin. The combination is recommended by World Health Organisation.

Dinev, however, said the quality and effectiveness of uterotonics available in low and middle-income countries is often low and as result, uterotonics fail to prevent postpartum haemorrhage.

Challenges

She said that despite its effectiveness, oxytocin must be stored in a cold storage to remain potent in temperature of between 2°C - 8°C. Short of that, the drug will not work.

"Oxytocin, which is recommended by WHO as the first-line medicine for prevention and treatment of postpartum haemorrhage, is temperature-sensitive medicine and requires refrigeration during transportation and storage," Deniv said.

"Quality issues in low and middle‑income countries arise due to substandard manufacturing and degradation due to heat exposure. There are also only a handful of certified manufacturers," she said.

The drugs have been proven and are quality life-saving medicines that need to be available for every woman.

Deniv called upon governments and policy makers to put in place systems and programmes to ensure that quality essential maternal health medicines are available for every birth.

For a drug to be considered of appropriate quality, it must be produced in accordance with the WHO's Good Manufacturing Practices (GMP), be proven to be safe and efficacious and contain 90-110% of the Active Pharmaceutical Ingredient (API) amount stated on the label.