Maternal deaths: CHR tasks FG, states on procurement of drugs for prevention of PPH

January 10th, 2019

…Applauds WHO over guidance update

By Hassan Zaggi

Community Health and Research Initiative (CHR)- a Non Governmental Organisation (NGO), has advised the Federal and 36 state governments to invest considerable amount of resources in the procurement of drugs meant for the prevention and treatment of the Post Partum Hemorrhage (PPH).

PPH is excessive bleeding by mothers after child birth and is  said to be the leading direct cause of maternal deaths.

CHR has, therefore, applauded the World Health Organisation (WHO) for updating the guidance to prevent PPH.

The updated guidance is aimed at improving the quality of care and health outcomes for women giving birth.

According to WHO, about 14 million women around the world suffer from postpartum haemorrhage every year.

Children who lose their mothers  at the point of delivery face a much greater risk of dying within one month compared to babies whose mothers survive.

In a statement signed by itsExecutive Director, Salisu Musa Muhammad, CHR called on “President Muhammadu Buhari and the 36 States Governors to invest a certain percentage of the annual health budget for the procurement, storage and distribution of drugs that will prevent postpartum hemorrhage, including carbetocin which is important in saving the lives of mothers and babies.”

While applauding the WHO for updating the guidelines, CHR described the development as encouraging, reiterating that it can revolutionize the ability to keep mothers and babies alive, especially in the developing and African countries where stable electricity to preserve these drugs is inadequate.

According to  the CHR Executive Director: “This is a good development for improving quality maternal health drugs, especially for Africa and Nigeria where maternal deaths through PPH are very high.

“While we welcome this new guidance, we therefore call on the Nigerian government to invest in these drugs as it will go a long way in preventing PPH in the country.”

CHR however, lamented that: “Shockingly, 99% of the deaths from PPH occur in low- and middle-income countries compared with only 1% in high-income countries although recent studies are showing that it is increasingly an issue of concern for wealthier countries too.

“It is hoped that with these new guidelines, healthcare workers globally will be able to stop women and their babies from facing unnecessary risks to their health and lives, wherever they live.”

 The new guidance recommended by the WHO stated that: “ Any one of the following uterotonics can be used for the prevention of PPH: oxytocin, carbetocin, ergometrine/methylergometrine, oxytocin and ergometrine fixed-dose combination and misoprostol. 

In settings where multiple uterotonic options are available, oxytocin (10 IU, IM/IV) is the recommended uterotonic agent for the prevention of PPH for all births. 

In settings where oxytocin is not available, or its quality cannot be guaranteed, the use of carbetocin, or if appropriate ergometrine/methylergometrine, or oxytocin and ergometrine fixed-dose combination, or oral misoprostol is recommended. 

Where the quality of oxytocin is considered compromised due to inadequate cold-chain transport and storage conditions, heat-sensitive uterotonic agents such as ergometrine/methylergometrine or oxytocin and ergometrine fixed-dose combination, that have been transported and stored under similar conditions as the oxytocin, are not suitable options. In these situations, heat-stable uterotonic agents (carbetocin or misoprostol) are suitable options depending on the context.  

All the uterotonics recommended for postpartum haemorrhage prevention, can be used in women undergoing vaginal birth or caesarean section, and require, except for misoprostol, a skilled health personnel trained to administer injectable uterotonics.

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