“Bleeding after childbirth is one of the largest contributors to maternal deaths in low income countries, and accounts for nearly one quarter of all maternal deaths worldwide,” said Dr Fauziah Rabbani, Professor and Interim Chair, Department of Community Health Sciences (CHS), Aga Khan University, at a seminar on Misoprostol – a drug to help stop post-birth bleeding faster and reduce blood loss to save the lives of mothers at risk in Pakistan. The seminar was held at the University to disseminate the findings of community-based Misoprostol trials in Northern Pakistan.
Dr Rabbani highlighted the need for safe and low-cost interventions to help mothers survive bleeding after childbirth. Jill Durocher, Gynuity Health Projects, USA, pointed out that two-thirds of births take place at home in Pakistan, and less than half of those are attended by any skilled healthcare provider. In hospitals when birth complications cause severe bleeding, women are generally given an oxytocin injection to control the blood loss. But the injection – whilst still the most effective treatment available – is expensive and needs to be administered by a skilled health care professional – restricting its use in low income and rural areas of Pakistan. “Many births in rural setting are attended by family or community members, not health providers. An unskilled attendant may not possess the skills to administer the injection, and in some cases, local laws may prohibit their use. When post-birth bleeding occurs, quick treatment is needed; a woman may die within one hour, leaving little time for her to be taken to a local health care unit or hospital.”
Misoprostol, a tablet, provides an alternative treatment for after-birth bleeding. The tablet is easy to transport and store, can be taken orally, is inexpensive and widely available. “Given the low cost and ease of use, Misoprostol has the potential to save women’s lives, particularly in resource-poor settings,” said Durocher. Dr Nadeem Zuberi, Assistant Professor, Department of Obstetrics and Gynaecology, AKU, agreed and added, “If we can provide training to community midwives and other health care personnel, they can play an important role in providing high quality and accessible care at an affordable price.”
Dr Juanita Hatcher, Professor and Local Principal Investigator, CHS, explained that the community-based survey was designed to check the effects of Misoprostol in preventing bleeding after birth in Pakistani women. The study was conducted from 2005 to 2008 in the remote areas of Chitral, where deliveries are commonly carried out by traditional birth attendants. Nearly 1,400 mothers between the ages of 15 and 45, with at least one living child, participated in the survey, overseen by traditional birth attendants, lady health visitors and community health nurses at 17 primary care facilities within the Aga Khan Health Service, Pakistan (AKHS,P) network. A dose of Misoprostol was given to women delivering at home, during their third stage of labour, right at the time of child birth. The results were encouraging: bleeding stopped within 20 minutes after delivery and post-birth bleeding reduced by 25 per cent. “This means that this medicine is a safe and effective alternative intervention for use during home deliveries, where injections are either not available or unfeasible,” said Dr Zafar Ahmad, General Manager, NWFP and Punjab, AKHS,P.
“The potential impact of Misoprostol is huge. If effective, it could be administered at all levels of the health care system and by all levels of providers – bridging the gap between need and services,” said Jennifer Blum, Senior Program Associate, Gynuity Health Projects.
The seminar was organised by CHS, in collaboration with the Department of Obstetrics and Gynaecology, AKU, Gynuity Health Projects, USA and AKHS,P, who also helped conduct the study, with funding from the Bill and Melinda Gates Foundation.
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