Kenya intensifies efforts to vaccinate pregnant women

The medicine is part of the government’s arsenal to tackle runaway maternal mortality statistics in some counties

The government has procured 360,000 doses of a new formulation of a drug that prevents excessive bleeding following childbirth, medicine meant to prevent excessive bleeding during childbirth. The consignment is set to arrive in the country in March.

The medicine, Heat Stable Carbetocin, does not require refrigeration. It is also still effective for at least three years stored at 30 degrees Celsius and 75% relative humidity. Dr Edward Serem, the head of the division, said that the government has been following the World Health Organisation’s recommendation to use another medicine called Oxytocin as the first-choice drug for preventing excessive bleeding after childbirth. However, Dr Serem said, oxytocin must be stored and transported at between 2 and 8 degrees Celsius.

In a statement to reporters at the Kenya Obstetrical Gynaecological Society (KOGS) conference in Mombasa, Dr Serem said: “Not many counties can sustain these levels of refrigeration, and that means when the women get the medicine for preventing the bleeding, it has completely lost its potency because of exposure to higher temperatures.”

Postpartum haemorrhage (PPH), in which women bleed uncontrollably after childbirth, is the deadliest of all complications during childbirth. A 2017 investigation into all the deaths of mothers by the Ministry of Health showed that PPH is responsible for two in every five women who die in Kenya during and after childbirth in Kenya. Failure of the uterus to contract adequately after childbirth is the most common cause of postpartum haemorrhage.

Michael Mwiti, a midwife and maternal health specialist from the Johns Hopkins affiliate, Jhpiego, said: “When the woman who is bleeding does not get appropriate action, that includes medicine, she dies within a few hours.”

When the woman does not die, the complication may force doctors to perform emergency hysterectomies (removing the uterus), especially when hospitals have too little blood on hand to provide transfusions.

The government settled on the medicine following Kenya’s participation in the world’s largest clinical trial called Carbetocin Haemorrhage Prevention, known to many as the CHAMPION Trial. The study tested the effectiveness of the medicine alongside Oxytocin on 30,000 women who gave birth vaginally in Argentina, Egypt, India, Kenya, Nigeria, Singapore, South Africa, Thailand, Uganda, and the United Kingdom. The results published in the New England Journal of Medicine showed it to be safe and effective just as oxytocin, which Kenya has used all along.

Maternal mortality remains high in Kenya, placing it in the category “very high” category of the World Health Organisation. While lack of medication was one of the causes of excessive bleeding remained stubbornly high, the Ministry of Health’s 2017 report indicated that “91% of women who died received suboptimal care, where different management would have resulted in a different outcome”.

The report further highlighted that the suboptimal care was due to inconsistent treatment practices that do not adhere to the guidelines, lack of equipment, poor referral system and understaffed hospitals. In response to the arrival of the medicine, the government solicited support from multiple development partners and donors to train healthcare workers to identify postpartum haemorrhage so that they can start the treatment using the new medicine.

The project Smile for Mothers trained more than 300 healthcare workers in 40 public health facilities in ten counties with stubbornly high levels of post-partum haemorrhage: Kilifi, Garissa, Kitui, Tharaka Nithi, Kiambu, Nairobi, Nakuru, Kakamega, Kisumu, and Migori.

UNITAID-backed project Accelerating Measurable Progress and Leveraging Investments for Postpartum Haemorrhage Impact—AMPLIPPHI, pronounced Amplify— tested the integration of medicine in a health system in Makueni County.

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