BIRMINGHAM, England — Maternal mortality rates are alarmingly high in the developing world, but the newly developed E-MOTIVE intervention proposes to dramatically improve outcomes for mothers. In countries like Kenya, where poverty is widespread, this simple approach could significantly reduce maternal deaths, but a national effort to prioritize implementation may be required.
The leading cause of maternal mortality in Kenya is postpartum hemorrhage, defined as more than 500 milliliters of blood loss after birth, which kills the equivalent of one woman every six minutes. A recent study in collaboration between the University of Birmingham and the World Health Organisation proposes a new approach to treating the condition, showing a significant 60% reduction in severe outcomes, including deaths.
The new intervention involves early hemorrhage detection using a calibrated drape and concurrently implementing several treatments once the patient has lost 500 milliliters of blood. Dr. Idnan Yunas, one of the researchers in this study, emphasizes the significance of early detection in low-income countries, where a critical level of blood loss often occurs before hemorrhage is detected.
The study consisted of an international randomized trial with hospitals in Kenya, Nigeria, South Africa and Tanzania. While the trial demonstrated the potential for a significant reduction in maternal mortality in Kenya, researchers are keen to ensure that the centers involved can continue to roll out interventions beyond the trial period.
In a visit to the Malindi Sub-County Hospital, situated on the East Coast of Kenya, Dr. Yunas noted both the strains upon the Kenyan health care system and the resourcefulness of the Kenyan medics in their efforts to continue implementing the intervention. Despite limited facilities and the expense of acquiring calibrated drapes, doctors in Malindi took the initiative to “modify and develop their own drapes,” using a bowl with gradations instead of a funnel. In the face of understaffing and limited resources, efforts are being made to develop “clinical best practice.”
In 2020, almost 95% of all maternal deaths occurred in low and lower-middle-income countries. Since the majority of these deaths result from preventable and treatable conditions, inequitable access to quality health care is clearly a major concern, with those in poverty suffering the most.
In Kenya, access to health care varies across the country. With over 43% of the population living in poverty and 70% in medically underserved rural areas, it is unsurprising that maternal mortality is unacceptably high. In 2017, roughly two-thirds of all maternal deaths occurred in Sub-Saharan Africa, where Kenya is located.
According to the World Health Organization, there are various factors that prevent women from receiving and seeking care. These include inadequate numbers of qualified health workers and limited supplies. Dr. Yunas says that due to existing strains on hospitals, “the interventions rolled out have to be simple”. The E-MOTIVE intervention is simple enough to make implementation feasible, and the treatment can be carried out by midwives as well as doctors.
Yet other factors contribute to maternal mortality in Kenya, including harmful gender norms and lower prioritization of maternal care. Dr. Yunas says that making “women’s health more of a priority” will advance the effort to achieve widespread implementation.
There is clearly much work to be done, but with dedicated and innovative workers such as the Malindi Sub-County Hospital medics, the future looks brighter for maternal health care in countries where poverty and mortality are widespread. With the appropriate response from governments and NGOs, researchers hope to see the E-MOTIVE being used globally in the coming years, potentially saving thousands of lives annually.
– Anum Mahmood