LAGOS, Nigeria (VOICE OF NAIJA)-As Nigeria grapples with one of the highest maternal mortality rates in the world, stakeholders are urging the government and healthcare providers to take immediate action to address the leading cause of maternal deaths: post-partum hemorrhage (PPH).
Despite being a preventable condition, PPH accounts for a significant proportion of maternal deaths globally, with Nigeria bearing a disproportionate burden.
Dr. Adebayo Awoniyi, a consultant obstetrician and gynaecologist, warns that the situation is dire and demands a multifaceted approach to improve maternal health outcomes.
Awoniyi listed uterine atony, trauma, retained placental tissue, coagulation disorders, among others, to be the primary causes of PPH.
“PPH is defined as the loss of more than 500ml of blood within 24 hours after vaginal delivery or more than 1000ml after cesarean section. It accounts for a substantial proportion of maternal deaths globally, with Nigeria having one of the highest mortality rates. Addressing this problem is essential for achieving the Sustainable Development Goal (SDG) of reducing the global maternal mortality ratio,” Awoniyi noted.
He added: “Preventing maternal deaths from postpartum hemorrhage in Nigeria requires a multi-faceted approach, including improved healthcare infrastructure, trained personnel, efficient supply chains, community engagement, and strong policy support. By addressing these challenges, Nigeria can make significant strides toward reducing maternal mortality and improving the health and well-being of mothers and their families.
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“More importantly, we must work towards prevention, and some actions to take will include good antenatal care which involves regular antenatal visits; monitoring and managing risk factors such as anemia and hypertensive disorders; iron and folic acid supplementation to prevent anemia.
“It is also good to use skilled birth attendants. This involves training of health workers, ensuring that midwives and obstetricians are skilled in PPH management and prevention, and also ensuring the availability of essential medicines and surgical interventions.
“There is also the Active Management of the Third Stage of Labor (AMTSL), which includes the use of Oxytocic, Prophylactic use of uterotonic drugs to prevent uterine atony, proper technique to deliver the placenta and uterine massage. “The World Health Organisation (WHO) has however recommended use of the E-MOTIVE bundle, which is a modification of the response to detection and management of women with PPH. E-MOTIVE stands for E- Early bleeding detection using a calibrated drape; Uterine massage; O- Use of medication (Oxytocic); T -Use of Tranexamic acid; IV- Intravenous fluids; E-Genital tracts examination and escalation when necessary. This new approach advocates that all components of the bundle are given in the shortest possible time without waiting for a response to individual interventions.”
While policies and programs exist, inadequate funding is hindering their effectiveness, according to Ayo Adebusuyi, Chairman of the Lagos State Advocacy Group on women’s health.
He emphasizes the need for increased funding to reduce maternal deaths in Lagos State by 20% by 2030.
He noted: “Our women’s health initiative focuses on women’s health generally, though post-partum bleeding tops the chart on causes of maternal deaths. The overriding goal is to reduce maternal death in Lagos State by 20 per cent, by the year 2030. We agreed on many specific smart objectives, one of which is to push for more funding because whatever we are talking about needs funding to be effective.
“There are many policy guidelines on maternal health, but funding is paramount to make them effective…”
The Lagos State government has pledged to domesticate the World Health Organization’s (WHO) E-MOTIVE bundle, a comprehensive approach to preventing and managing PPH, by the third quarter of the year. However, experts stress that action is needed now to stem the tide of maternal deaths.
Permanent Secretary in the Ministry of Health Dr. Olusegun Ogboye said: “We are set to domesticate the guidelines at state level by third quarter of the year. We have also reviewed and are updating our protocols with the obstetrics and gynaecology departments in all state-owned hospitals to include the EMOTIVE bundle in their treatment modules.
“We are also working to bring stakeholders together to review it and adapt it for our own situation in Lagos State.”