Every single day, endless mothers around the sector lose their lives to postpartum haemorrhage (PPH), a devastating truth that remains a frequent and chronic divulge in Nigeria. The country accounts for 28.5% of world maternal deaths, with PPH being a main contributor, causing 22% of those tragic losses.
A webinar hosted by Smiles for Mothers in collaboration with Nigeria’s Ministry of Health and Social Welfare and Ferring Prescribed tablets, introduced leading experts together to talk about the “Best Practice on the Use of Heat-Stable Carbetocin (HSC) and Other Uterotonics for Prevention of Postpartum Haemorrhage (PPH) in Nigeria“.
As healthcare methods in low-handy resource settings continue to struggle with inconsistent chilly chain infrastructure, HSC offers a leap forward solution by maintaining its efficiency at higher temperatures, improving acquire admission to to effective PPH administration solutions.
Other Uterotonics and the draw they faired
Oxytocin is the latest gold customary and first-line agent in the prevention and therapy of PPH due to its efficacy and fast onset of motion. Then again, one in all the ultimate barriers of using oxytocin to effectively organize PPH in Nigeria is its dependence on a functional chilly chain intention from the point of invent to the point of employ.
This life-saving, then again requires refrigeration at 2°C to 8°C to maintain its effectiveness. But, many rural clinics and main healthcare centres (PHCs) struggle with constant energy present. Up to 40% of PHCs in Nigeria lack acquire admission to to electricity, making chilly storage unreliable. Which potential that, oxytocin in most cases loses its efficiency sooner than it is going to also additionally be administered, rendering it ineffective in preventing excessive bleeding after childbirth.
Naanma Kangkum, Manager at Solina Centre for International Pattern and Research (SCIDaR) eminent during the webinar that findings from a national audit of uterotonics in Nigeria revealed that 74% of oxytocin samples failed efficiency tests due to scandalous storage and unsuitable production. The audit additionally revealed that 34% of misoprostol samples, one other fashionable uterotonic, failed to meet required efficacy requirements. Highlighting the industrial impact, Kangkum eminent that unhappy-quality uterotonics impress Nigeria an estimated $73 million every twelve months due to therapy failures and increased healthcare prices.
Unlike oxytocin which requires refrigeration, HSC eliminates the chilly chain divulge as it remains exact at temperatures up to 30°C. This makes it remarkable more honest appropriate in low-handy resource settings where maintaining a relentless chilly chain is sophisticated.
According to Dr. Vishal Shah, Director at Ferring Prescribed tablets who spoke during the webinar, “Heat-Stable Carbetocin represents a critical shift in how we approach PPH prevention. It reduces the burden on healthcare providers while ensuring consistent effectiveness in resource-limited settings.”
The efficacy of HSC: The CHAMPION Trial
The CHAMPION trial, one in all the ultimate research on uterotonics, confirmed that HSC is as effective as oxytocin in preventing PPH. The trial used to be performed all over 10 international locations with over 29,000 women folks and demonstrated that HSC led to similar reductions in blood loss while offering the added honest appropriate thing about temperature steadiness. The CHAMPION trial found that HSC can final 4 to 10 events longer than oxytocin, enabling prolonged uterine contraction with a single 100 micro grams injection, administered intravenously or intramuscularly, and reducing the need for a pair of doses. Using HSC for PPH prevention used to be additionally found to be more impress-effective in contrast to other uterotonics (oxytocin, misoprostol), meaning that over time, using it ought to vastly cut healthcare spending associated to treating PPH complications.
Speaking extra, Naanma highlighted that the Smiles for Mothers programme has collaborated with assorted stakeholders since 2020 to enhance the roll out and adoption of WHO ideas of uterotonics for PPH prevention, particularly HSC, via three (3) journeys:
1. Protection Adoption Chase: States and the National Authorities had been supported in developing a costed roadmap for adopting the 2018 WHO ideas on the employ of uterotonics for the prevention of postpartum haemorrhage, particularly advocating for heat-exact formulations in low-handy resource settings. This assignment additionally facilitated policy opinions, updates to the A must-have Medicines Listing, revisions to training manuals, and securing a regulatory approval from NAFDAC for the importation and employ of HSC in Nigeria.
2. Product Chase: Collaboration with states comparable to Kano, Lagos and Niger to integrate HSC procurement planning into their operational plans. Supplied enhance for healthcare employee training and assisted states in seeding HSC into their Drug Revolving Fund (DRF), leading to sustained procurement over time.
3. Patient Chase: Performed implementation research to assess wisely being employee acceptability of HSC, while additionally building the ability of clinical examiners in active administration of the third stage of labour (AMTSL). Additionally, provided patient literacy offers to women folks in communities to generate interrogate for wisely being products and services within native wisely being facilities.
Speaking during the webinar, Dr. Chukwunonso Nwaokorie, Principal at Solina Centre for International Pattern and Research, highlighted that a public-acquire admission to priced version of HSC Carbetocin is now on hand in the Nigerian market. This used to be made attainable via a partnership between MSD for Mothers, Ferring Prescribed tablets, and the World Health Organisation (WHO).
Scaling the Utilize of HSC via the MAMII Approach
At the Joint Annual Review (JAR) meeting that held in November 2024, the Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, launched the Maternal Mortality Reduction Innovation Initiative (MAMII) with the aim to cut maternal mortality in Nigeria by increasing facility utilisation, promoting deliveries by skilled birth attendants and reducing maternal and neonatal mortality by 30% in 172 priority Local Authorities Areas (LGAs). These LGAs, spread all over 33 states, accounts for over 50% of maternal deaths in Nigeria.
Key present aspect interventions of the MAMII intention include training 120,000 frontline healthcare workers; improving PHC efficiency and expanding General Healthcare Provision Fund (BHCPF) main healthcare centres (PHCs) to 17,600; deployment of Maternal and Neonatal Health (MNH) innovations and ensuring the offer of responsive emergency administration and referral methods, and sustainable wisely being financing. Deploying and scaling of HSC as a key MNH innovation can also additionally be executed via the following in truth handy actions:
· Strengthening procurement and present chain methods: The Federal Authorities of Nigeria ought to quiet allocate funds to scale up the procurement and distribution of HSC all over all states. To be certain that constant availability, procurement guidelines ought to quiet additionally be developed on the national and relate ranges with a spotlight on preventing stockouts and promoting equitable distribution, especially in LGAs where the burden of maternal mortality is best.
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· Expanding PHC facility ability: A core aim of MAMII is the expansion of BHCPF to 17,600 functional PHC facilities nationwide. These PHCs ought to quiet be adequately geared up with important maternal wisely being commodities, including offers for prevention, identification and therapy of PPH bask in heat exact uterotonics and calibrated drapes, and other formulation of the E-MOTIVE therapy bundle.
· Training and ability building for healthcare suppliers: The MAMII intention targets to train 120,000 frontline healthcare workers to give a increase to maternal wisely being carrier offer. Professional associations comparable to Society of Gynaecology and Obstetrics of Nigeria (SOGON) and National Affiliation of Nigerian Nurses and Midwives (NANNIM) ought to quiet facilitate workshops and trainings to upskill clinical examiners on the greatest practices and the effective employ of HSC for the prevention of PPH. These training classes ought to quiet be incorporated into pre-carrier and in-carrier curriculum of healthcare workers.
· Ensuring sustainable financing for HSC Procurement: The MAMII intention seeks to integrate innovative financing mechanisms to enhance maternal wisely being interventions. To guarantee sustainable present, the federal govt ought to quiet incorporate HSC procurement into the General Healthcare Provision Fund (BHCPF) allocations and be certain that that HSC is covered under maternal wisely being insurance advantages.
Preventing PPH is severe to improving maternal wisely being outcomes and HSC offers a promising solution due to its efficacy and suitability for low-handy resource settings. By adopting easiest practices in its utilisation and aligning it with the Federal Authorities’s MAMII intention, stakeholders can work together to vastly cut the burden of PPH and put the lives of endless mothers in Nigeria.
