Seven medical innovations or treatments, most of them easy to implement and low-cost, could significantly reduce maternal and infant deaths around the world, especially in sub-Saharan Africa and South Asia. It is the conclusion of the latest Goalkeepers 2023 annual report, published by the Bill and Melinda Gates Foundation this Tuesday. “By making new innovations accessible to those who need them most, two million additional lives could be saved by 2030 and 6.4 million lives by 2040,” estimates the large philanthropic entity in its annual report that places emphasis on maternal and child mortality, whose progress has stalled since 2016 and in some countries, including the United States, has even increased.
Among these innovations are rapid diagnosis of postpartum hemorrhage, an intravenous iron injection for anemia, a probiotic supplement for babies, prenatal corticosteroids (anti-inflammatories) for women who will give birth prematurely, azithromycin (an antibiotic) to reduce infections or a portable ultrasound device with artificial intelligence to monitor high-risk patients in low-resource settings.
In 2015, world leaders agreed on 17 Sustainable Development Goals with an eye toward 2030. The year 2023 represents the equator, that is, halfway to those goals. And, in the case of maternal, child and neonatal maternity, the data indicate that there is still a long way to go. The goal set then was to end all preventable child deaths by 2030 and reduce maternal mortality to 70 out of every 100,000 births. That hasn’t happened. Every day 800 women die around the world from reasons related to pregnancy and childbirth. That is, one every two minutes. 70% of these deaths occur in sub-Saharan Africa, according to the UN. Additionally, each year, approximately five million children die before reaching the age of five. Nearly two million more babies die before taking their first breath: they are stillborn.
And this, despite the fact that according to the report, there has never been so much scientific knowledge on maternal and child health. “Researchers have learned more about the health of mothers and newborns in the last 10 years than in the entire previous century,” the report states. The problem is that the solutions do not reach those who need them most. The authors even speak of an “epidemic of maternal and child mortality,” not only in low-income countries. In the United States, for example, mortality among black mothers has doubled since 1999. “American women are three times more likely to die during childbirth than women in almost all other wealthy countries. But those who are most affected are black and indigenous women,” says Melinda French Gates.
In the 2000s, indicators of human well-being such as poverty or education improved substantially and it was precisely maternal and child health that progressed the most. This was possible, in part, because several international organizations set ambitious objectives, which, however, were truncated starting in 2016 and which ended up stagnating with the arrival of the covid-19 pandemic. There are countries like Venezuela or the United States where it has even increased, according to the report.
Three low-cost lifesavers
According to Melinda French Gates, three low-cost innovations can prevent thousands of women in lower-middle-income countries from dying during pregnancy and childbirth: a new treatment for postpartum hemorrhage, the use of the antibiotic azithromycin to prevent infections, and the injection intravenous iron in cases of anemia.
Postpartum hemorrhage (PPH), that is, losing more than half a liter of blood in the 24 hours following childbirth, is the leading cause of maternal death. The World Health Organization (WHO) estimates that it affects 14 million women a year, of which 70,000 die, especially in low-income countries. In impoverished countries the main problem is realizing that there is a significant loss of blood. In many places, this is only estimated visually and the consequence is that thousands of women die without receiving the treatment that could save them.
The Gates Foundation proposes a simple and cheap way to quantify this blood loss: an obstetric cloth that looks like a calibrated V-shaped plastic bag that is hung on the edge of the bed and the blood that falls into it rises like Mercury does it in a thermometer. It is a quick visual indicator that alerts healthcare personnel. Furthermore, instead of sequentially applying the five treatments to stop bleeding (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, and examination of the genital tract), it is proposed to group them together. In a study called E-MOTIVE, Nigerian obstetrician-gynecologist Hadiza Galadanci and a team of researchers from four African countries with a high maternal mortality rate found that this change managed to reduce cases of serious bleeding by a remarkable 60%.
Another of the proposed changes is the treatment of anemia, which affects 37% of pregnant women—although in some places in the world, such as South Asia, it can reach up to 80%—and increases the chances of hemorrhage during childbirth. . Diagnosing it during pregnancy is essential, but instead of treating it with oral iron supplements that must be taken for 180 days, Bosede Afolabi, a Nigerian obstetrician and researcher, is working to implement a promising new intervention in her country: a single infusion intravenous iron injection that lasts 15 minutes and can replenish women’s iron stores.
Another of the main causes of maternal mortality is infections. In recent years, researchers have discovered that one of the most promising new ways to prevent infections during pregnancy is the administration during childbirth of one of the most used antibiotics in the world: azithromycin. In a study in sub-Saharan Africa, it reduced cases of sepsis (an extreme inflammatory reaction) by a third.
“These advances are not silver bullets on their own: they require countries to continue to hire, train and equitably remunerate health professionals, especially midwives, and build more resilient health systems. But together they can save the lives of thousands of women every year,” estimates Melinda French Gates.
The baby knowledge boom
“Over the last decade, the field of children’s health has advanced faster and further than I thought I would see in my lifetime,” says Bill Gates, highlighting the launch of three Gates Foundation programs to investigate the deaths of children and newborns in order to prevent them: CHAMPS (Child Health Surveillance and Prevention of Mortality, in its acronym in English); PERCH, which examines the causes of childhood pneumonia, and GEMS, on diarrheal diseases.
Ten years ago, he continues, “any record of a child’s death listed one of the four most common causes: diarrhea, malnutrition, pneumonia, or premature birth.” “But each of them covered a vast ocean of different diseases, with dozens of different causes and treatments; Pneumonia, for example, is related to more than 200 types of pathogens,” adds Gates.
The collection of data in recent years, through taking blood and tissue samples from children who had died, and comparing cases, has revealed that some pathogens were less likely than expected, such as the one that causes cough whooping, while others were more common, such as klebsiella, which is more difficult to treat. This new information about this last bacteria “is allowing doctors to review which antibiotics to administer,” explains Bill Gates. It’s what he calls “the baby knowledge boom.” “Thanks to studies such as those carried out by CHAMPS, PERCH and GEMS, health professionals are beginning to understand precisely when and why some babies die, allowing them to save the lives of others,” he notes.
Another example that Gates highlights is how doctors help premature babies breathe, with the administration of prenatal corticosteroids (ACS) to the pregnant mother when labor is expected to be early. According to the foundation’s calculations, “ACS could save the lives of 144,000 babies in sub-Saharan Africa and South Asia by 2030, and almost 400,000 by 2040.” Also providing probiotic supplements with bifidobacteria, bacteria that live in the digestive system and help break down milk sugars, reduces the risk of death or serious illness in premature babies.
Planeta Futuro is a project in collaboration with the Bill and Melinda Gates Foundation for journalistic coverage of sustainable human development issues.
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