By Clifford Akumu

In a move aimed at reducing maternal mortality in Kenya, the government has procured 360,000 doses of a new medication that prevents excessive bleeding after childbirth. The consignment is set to arrive in the country in March, 2024.

The medication, Heat Stable Carbetocin, was added to the World Health Organization (WHO) Essential Medicines List of uterotonics for the prevention of excessive bleeding after childbirth in 2019.

The drug does not require refrigeration and is effective for at least three years when stored at 30 degrees Celsius and 75% relative humidity.

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

He noted that oxytocin must be stored and transported at between 2 and 8 degrees Celsius, which not many regions in Kenya can sustain. This means that when the women get the medicine for preventing the bleeding, it has completely lost its potency because of exposure to higher temperatures.

Postpartum haemorrhage (PPH), in which women bleed uncontrollably after childbirth, is the deadliest of all complications during childbirth.

A 2017 investigation into all maternal deaths by the Ministry of Health showed that PPH is responsible for two in every five women who die in Kenya during and after childbirth. Failure of the uterus to contract adequately after childbirth is the most common cause of PPH.

Michael Mwiti, a midwife and maternal health specialist from the Johns Hopkins affiliate, Jhpiego, said: “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.”

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 at hand to provide transfusions.

The government is including the new drug 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.

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

While lack of medication was one of the causes behind excessive bleeding remaining stubbornly high, the Ministry of Health’s 2017 report indicated that “91% of women who died received suboptimal care, where different management 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 1400 healthcare workers in 40 public health facilities in ten counties which have reported high levels of PPH: Kilifi, Garissa, Kitui, Tharaka Nithi, Kiambu, Nairobi, Nakuru, Kakamega, Kisumu, and Migori.