The Ministry of Health and Wellness (MoH&W) has not included carbetocin in its drugs that reduce excessive bleeding following childbirth amongst its Essential Medicines List despite high maternal deaths caused by excessive bleeding.
The study, published in the New England Journal of Medicine, shows that this alternative drug is heat stable, safe and effective as oxytocin in preventing postpartum haemorrhaging.
This new formulation of carbetocin does not require refrigeration and retains its efficacy for at least three years stored at 30 degrees celsius and 75% relative humidity.
MoH&W chief public relation officer, Doreen Motshegwa pointed out that carbetocin is not included in the list because Oxytocin has been selected as the drug of choice for Botswana.
She said that the ministry has however selected oxytocin, ergometrine and a combination of oxytocin plus ergometrine, which are included in the Botswana Essential Medicines List.
She said the three medicines listed above have been on the Ministry’s Essential Medicines List for over 25 years and are available to health personnel providing maternal health services.
“Ergonetrine is very effective if administered on time (at the right time when it is needed without delay) and correctly (slow intravenous injection).
However, these drugs have side effects such as nausea, vomiting, irregular heartbeat and headache,” she noted.
Motshegwa further emphasised that the ministry embarked on several strategies to accelerate reduction of maternal mortality.
She pointed out that those strategies include capacity building on emergency obstetric and newborn care (EmONC) including comprehensive post abortion care where all District Health Management Teams (DHMT) have been covered that is done to revive the skills of health care providers to improve quality of care rendered to women.
“Our strategies also include Maternal Death Surveillance and Response where all maternal deaths are reported, audited and reviewed followed by a maternal mortality summit to further interrogate issues that lead to a woman’s death and develop action plans to reduce maternal mortality.
“We also have maternal mortality reduction initiatives where midwives’ coordinators have been assigned the responsibility to ensure adherence to emergency obstetric and newborn care protocols and guidelines in all health facilities,” she said.
Motshegwa added that they decided to decongest tertiary level of care to secondary and primary levels of care to ease and improve quality of care for referred patients, surgical skill acquisition training for Medical Interns.
Internship Programme for Medical Officers has been strengthened to ensure that each of them complete the internship being competent in doing basic surgical procedures like caesarean section, ectopic pregnancy, uterine evacuation and others.
Since 2015 to date,the MoH&W
They show that there are high maternal deaths caused by excessive bleeding following childbirth between January and July this year.
According to the ministry, amongst 33 maternal deaths recorded between January and June 12 mothers died due to excessive bleeding after giving birth.
This number is alarming compared to last year, as the ministry recorded 15 deaths resulting from excessive bleeding amongst the 74 maternal deaths recorded the same year.
However, in 2016 excessive bleeding caused 14 of the 85 maternal deaths. In 2015 the ministry recorded 12 excessive bleeding amongst 73 deaths recorded in the same year.
Recently, the World Health Organisation (WHO) recommended oxytocin as the first-choice drug for preventing excessive bleeding after childbirth.
WHO pointed out that oxytocin had to be stored and transported at two to eight degrees Celsius, which is hard to do, in many countries, depriving many women of access to this lifesaving drug. They explained that the drug might be less effective because of heat exposure when obtained by the patients.
A WHO report states that approximately 70,000 women die every year because of post-partum haemorrhage – increasing the risk that their babies also die within one month.
It stated that the clinical trial of carbetocin, the largest of its kind, studied close to 30,000 women who gave birth vaginally has been done in 10 countries such as Argentina, Egypt, India, Kenya, Nigeria, Singapore, South Africa, Thailand, Uganda and the United Kingdom.
“Each woman was randomly given a single injection of either heat-stable carbetocin or oxytocin immediately following the birth of her baby.
The study found that both drugs were equally effective at preventing excessive bleeding after birth,” it stated.
Since both drugs in the study were kept at temperatures required ensuring maximum efficacy of oxytocin, the trial may underestimate the benefit expected with heat-stable carbetocin use in real-life settings where oxytocin may have degraded due to exposure to higher temperatures.
“The development of a drug to prevent postpartum haemorrhage that continues to remain effective in hot and humid conditions is very good news for the millions of women who give birth in parts of the world without access to reliable refrigeration.
The next step is regulatory review and approval by countries,” says Dr Metin Gülmezoglu, from the Department of Reproductive Health and Research at WHO.