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Breastfeeding pegged on reduced maternal mortality

The World Breastfeeding Week, which runs from August 1 to 7, annually aims at focusing attention on the need to mothers to breastfeed their infants exclusively for the first six months of life.

This year’s theme was’ Support breastfeeding for a healthier planet’.

Unfortunately, unacceptably high number of women do not enjoy this privilege of breastfeeding their children because they never make it out of the delivery room alive.

Excessive bleeding or post-partum haemorrhage during or after child birth is the single highest killer of mothers in Africa.

According to the World Health Organisation (WHO) at least 295,000 women died during birth in 2017.

MATERNAL DEATHS

Sub-Saharan Africa alone accounts for roughly two-third (196,000) of these global maternal deaths.  This in itself is unacceptably high.

Mothers need to stay alive to provide their children with the best possible start in life – breastfeeding.

Breastfeeding delivers health, nutritional and emotional benefits for children and it forms part of a sustainable food system. Unfortunately, this is not a possibility for mothers who lose their lives while delivering their babies.

WHO, based on extensive new evidence, issued two recommendations for prevention and treatment of bleeding in women and included two new medicines in the WHO model list of essential medicines in 2019.

If these recommendations are implemented, they will contribute to the reduction in maternal mortality especially in low and middle income countries.

BLOOD LOSS

Administration of an effective uterotonic (these are drugs that help the uterus to contract and helps reduce blood loss during child birth) immediately after the birth of the baby has been shown to prevent PPH caused by the uterus failing to contract and is recommended by the WHO for all births.

Currently, most low and middle-income countries use oxytocin injection as the first line medicine for the prevention and treatment of PPH.

Oxytocin is a heat sensitive product that degrades when it is not kept refrigerated with temperatures of 2-8 °C (35-46 °F) throughout the supply chain, which can result in reduced effectiveness at the time of use, particularly in countries where reliable electricity and cold-chain may not be available.

Most countries in Africa use Oxytocin, a drug to stop bleeding during or after pregnancy, which requires cold chain. Many hospitals lack refrigeration facilities and also experience erratic power supply hence the efficacy of the drug becomes compromised. There are also many fake products in circulation.

COVID-19

Covid-19 has shown us that most of our health-care facilities are compromised in dealing with the pandemic be it human resource or equipment.

While most African countries  have stepped up and working on strengthening their healthcare systems, we should not forget the fact that maternal mortality still remains high in this region and that there is a cost effective solution available especially in our resource stretched economies.

The 2018 recommendations issued by WHO for drugs that support the uterus to go back to ‘its setting” after delivery now includes heat stable carbetocin as an option for prevention of bleeding for all births by a skilled birth attendant.

This particular drug is heat stable and a new formulation which retains its effectiveness for at least 36 months when stored at temperatures up to 30 degrees Celsius.

TRAUMA PATIENTS

Another drug that has been in use for years in reducing blood loss during surgery for trauma patients – Tranexamic Acid – is also part of the recommendation. While it had previously not been a go-to drug for reducing bleeding during birth, WHO has now included in the 2019 list of essential medicines with an obstetric indication- treatment of Post-Partum Haemorrhage (PPH).

These medicines, some new but some not so new are much needed on a continent that should not be losing mothers when there are ways to prevent it. While these medicines have been included in the essential drugs list by WHO, most African countries are yet to include them on their country’s lists.

For mothers to continue breastfeeding, they need to stay alive after delivery. To achieve this, we need to include drugs that work and that can maintain their efficacy even in resource strapped areas to save the lives of mothers and to contribute to the reduction of maternal mortality.

Joyce Ng’ang’a is the Policy Advisor at WACI Health


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