New drug to stem excessive bleeding

The government has procured 360,000 doses of a new formulation of a drug that prevents excessive bleeding following childbirth.

The medicine, Heat Stable Carbetocin, does not require refrigeration. It is also still effective for at least three years stored at 30°C and 75 per cent relative humidity.

Dr Edward Serem, Head Division of Reproductive and Maternal Health Services at the Ministry of Health, said Heat Stable Carbetocin will be used along with Oxytocin, which is the country’s first-choice drug for preventing excessive bleeding after childbirth.

However, Serem said, oxytocin must be stored and transported at a temperature of between 2°C and 8°C.

Levels of refrigeration

“Not many regions in Kenya 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,” he said.

Heat Stable Carbetocin is also effective due to a longer duration of action of the uterus.

Postpartum hemorrhage (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 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 that administration of medicines within one minute of childbirth is one of the most critical steps in preventing excessive bleeding after childbirth.

“Use of quality assured medicines is the game changer,” he added.

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 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.

Tested effectiveness

The study tested the effectiveness of the medicine alongside Oxytocin on 30,000 women who gave birth naturally 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. The Ministry of Health has also tested the medicine in 11 counties in Kenya.

Maternal mortality remains high in Kenya, placing it in the “very high” category of the WHO.

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 percent of women who died received suboptimal care, where different management measures 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 on the appropriate use of the medicine.

The project Smile for Mothers trained more than 1,400 healthcare workers in 40 public health facilities in 10 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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