GLOBAL: Village access to medicines, fewer maternal deaths
Photo: UNFPA  | | Mother with her newborn |
DAKAR, 29 September 2009 (IRIN) - Putting medicines for haemorrhage and infection in the hands of community health workers could mean significantly fewer maternal deaths in Africa, according to researchers at University College London (UCL).
The safest place for a woman to give birth is an equipped and staffed health facility, but in many countries such conditions do not exist and community-based access to drugs for two primary causes of maternal death should be studied, the researchers said in a paper published in The Lancet on 23 September.
“The reality for many is that a skilled attendant and a well-equipped facility is a distant dream,” said Anthony Costello, global health specialist and professor at UCL, one of the researchers.
“What we’re saying is, as in other areas of public health, the best should not be the enemy of the good.” He cited the example of villagers’ access to oral rehydration solution for children. “This has made a considerable impact on child health. Of course it is not the optimal care for dehydration but it’s the difference between something that could be quite effective, and nothing.”
More than half a million women die from pregnancy or childbirth complications per year – some 90 percent in Africa and Asia, according to the UN Population Fund (UNFPA).
Some top causes of maternal mortality as of 2005 were: haemorrhaging, infection, unsafe abortion, eclampsia and obstructed labour, according to the UN World Health Organization.
The UCL researchers developed a mathematical model to show the impact of making misoprostol (for haemorrhage) and antibiotics available through village health workers or volunteers. This community-based drug access would be in addition to strengthening health systems.
Dual approach
The researchers say the two approaches can be complementary. “We believe that debate about the relative merits of health system strengthening versus community intervention perpetuates a false dichotomy,” the paper said. “Both programmes are necessary to tackle maternal mortality and the correct balance of approaches crucially depends on the local context.”
Costello told IRIN: “We are not saying we should go and roll out these drugs in communities immediately but that this approach should be evaluated on a large scale and with mortality rates of mothers and infants carefully monitored."
In a 2008 report UNFPA said progress in some countries had led to a consensus in the global health community on three elements most effective in reducing maternal mortality and morbidity: universal access to family planning, a skilled health professional present at every delivery, and access to emergency obstetric and newborn care when needed.
“Lack of access to simple interventions such as oxytocics to prevent or treat haemorrhage or antibiotics to treat infection often leads to death or severe disability,” UNFPA says in a maternal health plan.
But community use of ueterotonic drugs is often resisted by obstetricians, Costello said. He said they call for the use of oxytocics which are injected, rather than misoprostol (administered orally). “But in most cases in these poorer countries it would be misoprostol or nothing.”
Luc de Bernis, UNFPA senior maternal health adviser, said community-based use of misoprostol for post-partum haemorrhage prevention is still not an established strategy, but said experts agreed on further study into the approach. “Safety and feasibility questions remain. Ongoing programmes focusing on this should be carefully monitored and evaluated.”
Johanne Sundby, specialist and professor in international health at the University of Oslo said given the weakness of health sectors in many countries there is not enough evidence that the facility-based approach works.
“There are two solutions to maternal mortality: bring the women to the services (and strengthen the services) or bring the services to the women,” Sundby said. “I am tempted to say yes – try to implement the latter, and research the evidence. The justification is there.”
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