Experts: Let’s use best global practises to cut maternal death

Dar es Salaam. Healthcare providers can help curb preventable maternal deaths in Tanzania if they adapt to innovative solutions and emerging global best practices in managing pregnancy-related complications, experts have said.

The stakeholders recently met with media professionals for an interactive session to explore innovative ways to cut maternal deaths in Tanzania.

These interventions include the management of excessive blood loss of 500 ml or more within 24 hours of birth (post-partum hemorrhage, or PPH), which still accounts for the highest number of deaths.

One of the notable developments that was highly discussed is the recent release by the World Health Organization (WHO) of ‘A Roadmap to Combat Postpartum Haemorrhage between 2023 and 2030, which was released after realizing that global efforts to tackle PPH “have failed to gain traction” over the past decade, despite the clear need to deal with the leading cause of maternal death.

The roadmap highlighted new medicines such as heat-stable carbetocin (HSC) and tranexamic acid (TXA), which have been found to be effective for PPH management over the last 30 years.

However, many countries in Sub-Saharan Africa, including Tanzania, still face challenges in updating their national guidelines and essential medicine lists to include the WHO-recommended postpartum hemorrhage medicines.

Vice President of the Association of Gynecologists and Obstetricians of Tanzania (AGOTA), Dr. Chetan Ramaiya, said there is an obvious need for improvement in the practice by adopting the new advanced best practices.

“But there is room for improvement. It is important that, as a country, we improve our treatment guidelines to accommodate the new life-saving medications and interventions that have shown effectiveness in reducing maternal deaths,” he said.

Dr. Ramaiya said the adoption of best practices will complement the ongoing efforts in the use of digital technology and other methods as well as the government’s investments and engagements with maternal health professionals in controlling maternal mortality.

Maternal deaths have remained stubbornly high in Tanzania, with current data indicating that 524 deaths still occur per 100,000 live births, with most of them attributed to pregnancy-related complications, mainly PPH.According to the current Demographic and Health Survey, which was last released in 2017, maternal mortality in Tanzania accounts for 524 out of 100,000 live births.

In January this year, WHO released a global estimate of MMR, indicating that deaths have been declining steadily but slowly over the years.

The estimates show Tanzania stood at 38/100000, with a lower limit of 174/100000 and an upper limit of 381/100000.

However, it’s not until a new Tanzania Demographic and Health Survey is released that the latest data on maternal deaths in Tanzania can be revealed.

Specialist in gynecology and former secretary general of the Medical Association of Tanzania (Mat), Dr. Lilian Mnabwiru, said the practice of medicine is evolving and there is a need to improve how we treat patients.

“For many years, we have relied on the use of uterotonics such as oxytocin, but in recent years, the WHO has recommended the use of carbetocin, which is heat-stable, and the use of tranexamic acid (TXA). These need to be incorporated into the national guidelines to accelerate the efforts to cut maternal deaths,” she said.

In her presentation, titled “Management of PPH: The Past, Present, and Future,” Dr. Mnabwiru highlighted other major causes of maternal deaths in Tanzania in addition to excessive bleeding. They include eclampsia, infections of the female reproductive tract, and abortion.

AGOTA’s President, Dr. Yahaya Kapona, said the new suggested drug (carbetocin) is a lifesaving drug that can help mitigate the serious PPH complication that takes the lives of many mothers in Tanzania.