• Since 2016, progress in reducing global maternal mortality has stalled, and in some countries, death rates have risen steadily
• In their essays published in the report, Melinda French Gates and Bill Gates call for immediate action
Image: ALPHONCE GARI
According to the 2023 Goalkeepers Report, since 2016, progress in reducing global maternal mortality has stalled, and in some countries, death rates have risen steadily.
Kenya’s maternal mortality was estimated at 530 deaths per 100,000 live births in 2020. This translates to about 6,500 women dying every year.
The recently published Kenya Demographic and Health Survey 2022 shows the infant mortality (under one year) rate was 32 deaths per 1,000 live births, and the neonatal mortality (in the first 28 days) rate was 21 deaths per 1,000 live births. Neonatal deaths account for 66 per cent of infant deaths.
In their essays published in the report, Melinda French Gates and Bill Gates call for immediate action to help the world achieve the global goal of cutting the maternal mortality rate to less than 70 out of 100,000 births and newborn mortality to 12 deaths per 1,000 live births by 2030.
They highlight seven life-saving innovations and practices, backed by tight evidence, that can be delivered by midwives and birth attendants in communities. They include:
1. A bundle of interventions that can reduce heavy bleeding after giving birth (postpartum hemorrhage), the number-one cause of maternal death, by 60 per cent for less than $1 (Sh150) per package.
The Goalkeepers Report recommends the use of calibrated obstetric drapes — essentially plastic bags that collect blood — to accurately determine how much blood a mother has lost, and provide immediate intervention if a certain level of blood loss is reached.
Current guidelines to treat postpartum haemorrhage (loss of more than 500ml of blood within 24 hours after birth) recommend administering five separate treatments, including uterine massage and IV fluids, sequentially. But a study published earlier this year, funded by the Gates Foundation, showed that administering these treatments all at once, in combination with an obstetric drape, reduced cases of severe haemorrhage by 60 per cent.
2. Bifidobacteria, a new probiotic supplement that, when given to an infant alongside breastmilk, combats malnutrition. This is one of the leading causes of newborn deaths, according to data provided by Child Health and Mortality Prevention Surveillance (Champs), a global health surveillance programme funded by the Gates Foundation.
The Goalkeepers Report estimates that the lives of 300,000 babies could be saved simply by giving newborns probiotic supplements containing bifidobacteria, which break down the sugar in breast milk and help babies absorb nutrients more efficiently. Expectant mothers can also give their children a head start toward a healthy birth weight and gut microbiome by consuming these supplements in late pregnancy.
3. Multiple micronutrient supplements (MMS) that boost survival rates for babies by helping replete nutrient stores in pregnant women and ensuring those vital nutrients are transferred to the baby. Expectant mothers usually take neonatal vitamins packed with iron and folic acid to support the health of their child. But MMS supplement is better. It contains 13 additional nutrients, including vitamins A, C, D and E, as well as zinc and other elements. They better tolerated than iron-folic acid tablets, and substantially reduce the likelihood a baby will be born prematurely and underweight.
4. A new one-time infusion of IV iron for women that replenishes iron reserves during pregnancy, protecting against and treating anaemia, a condition that is both a cause and effect of postpartum haemorrhage and affects almost 37 per cent of pregnant women.
5. Antenatal corticosteroids (ACS), which are given to women who will give birth prematurely to accelerate foetal lung growth, providing several weeks' of maturation in just a few days. Babies born prematurely often struggle to breathe because their lungs didn’t have time to finish developing in the womb. So when a woman shows signs of preterm labour, physicians can administer corticosteroids to help speed up the baby’s lung growth before birth.
6. Giving azithromycin during labour reduces maternal infections during pregnancy and prevents infections from spiralling into sepsis. It also reduces mortality when given to infants in high-mortality settings.
7. An AI-enabled portable ultrasound that empowers nurses and midwives to monitor high-risk pregnancies in low-resource settings to ensure that risks are diagnosed and addressed early. These devices are plugged into a mobile phone and, with a few quick swipes of a probe, can identify the position of the baby, position of the placenta and gestational age in about five minutes.