When Robert Omondi appeared before the Senate Health Committee in November 2022, he seemed dejected and felt short-changed by the system. He had just lost his wife, Maureen Anyango, in what he claimed to be a case of medical negligence. For eight hours, his expectant wife, whose delivery was due, waited on the bench, bleeding and in pain. She gave birth to twins, but she unfortunately died hours later. A post-mortem conducted by a government pathologist showed that she died of heavy bleeding and increased intracranial pressure –which is caused by excess fluids in the brain tissue....CONTINUE READING
Despite death being irreversible, there are many what ifs in Maureen’s case, and one of those is; what if there was a way her bleeding could have been stopped?
The World Health Organization (WHO) lists severe bleeding after childbirth as one of the leading causes of maternal deaths around the world. This is clinically known as post-partum haemorrhage (PPH).
A report released last year by WHO dubbed; Trends in Maternal Mortality shows that a woman dies during pregnancy or childbirth every two minutes.
A study published in the Reproductive Health journal shows that there is a 50 per cent chance of death of a baby whose mother died shortly after delivery.
In Kenya, a study published last year in the scientific journal Plos Global Health showed that post-partum haemorrhage is the leading cause of maternal deaths in the country. Data show that four in every 10 women in Kenya have died of excessive bleeding after giving birth.
The study showed that there were major gaps in containing such cases including delays that could have been prevented during post-delivery care. In fact, a study on the economic cost of post-partum haemorrhage conducted in Kenya, Ghana and the Ivory Coast shows that every year, about USD 57 104 042 (Sh 8.3billion) is lost.
The researchers recommended that an increased investment in blood supply would likely provide large cost savings in less than two years.
Even when such interventions are put in place, the Health Ministry last week updated a crucial drug that can stop bleeding to be part of Kenya’ Essential Medicines List.
The drug called Heat Stable Carbetocin has also been given subsidised pricing and will be available in all health facilities in the country. It was previously a preserve for only private facilities that may not be affordable to all Kenyan women who may need it. Heat Stable Carbetocin previously cost Sh1,444 and has now dropped to Sh92.
Before the inclusion of this drug, there was Oxytocin, which needed refrigeration before use, an exemption that this new drug has.
Dr Edward Serem, head of Division at the Reproductive and Maternal Health Services in the Health ministry, said the new drug will complement Oxytocin, which has to be stored and transported between two and eight degrees Celsius.
But the new drug can still be effective for at least three years stored at 30 degrees Celsius and a 75 per cent relative humidity.
“Not many regions in Kenya can sustain these levels of refrigeration, and that means when women get the medicine for preventing the bleeding, it has completely lost its potency because of exposure to higher temperatures,” said Dr Serem. Heat Stable Carbetocin is also more effective because of its longer duration of action of the uterus. The Kenya Medical Supplies Authority says the first batch of this medicine will arrive in the country next month.
The consignment will contain about 360,000 doses of the new formulation of the subsidised drugs.Another drug that has been included as part of the Essential Medicines List that will reduce maternal bleeding post-delivery is tranexamic acid. It is an old drug invented about seven decades ago, one which stops bleeding three hours after administration.
The government will use Makueni County as a pilot in the roll-out for the new drug to assess how it works.
The Health ministry is including the medicine as one of the options 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 New England Journal of Medicine showed it to be safe and effective just as Oxytocin.
Once the new drug arrives, the government will work with a number of development partners and donors to train healthcare workers on its appropriate use.
The government has since deployed about 1,400 healthcare workers in 40 public health facilities in 10 counties with high levels of post-partum haemorrhage: Kilifi, Garissa, Kitui, Tharaka Nithi, Kiambu, Nairobi, Nakuru, Kakamega, Kisumu, and Migori.
