Nakuru County is collaborating with the University of Nairobi and the World Health Organization (WHO) to conduct training programmes for health workers on ways of addressing Post-Partum Haemorrhage (PPH).
The initiative aims to provide critical evidence to guide national policy and shape future treatment protocols for the condition.
County Director for Health Planning and Administration, Dr Joy Mugambi, explained that the WHO backed programme targets to train nurses, midwives, doctors and clinical officers, focusing on emphasis on early detection, treatment and management of the childbirth complication.
The Director said that the programme will also carry out clinical trials and studies to evaluate the safety and effectiveness of a new drug intended to be used as a first-line treatment for postpartum haemorrhage.
According to Dr Mogambi, the clinical trials dubbed ‘Research to Expand Access to Heat-Stable Carbetocin (HSC) for the Treatment of Postpartum Haemorrhage’ (REACH) will incorporate the Nakuru County Referral and Teaching Hospital (NCRTH), Machakos Level 5 Hospital and Pumwani Maternity Hospital in Nairobi County.
She explained that the REACH Trial was a regulatory study aimed at evaluating the safety and efficacy of Heat-Stable Carbetocin (HSC) as a first-line treatment for postpartum haemorrhage, which she said was one of the leading causes of maternal mortality globally.
The Director said that findings from the trial are expected to provide critical evidence to guide national policy and shape future treatment protocols for PPH using Heat-Stable Carbetocin treatment.
Dr Mugambi explained that the training and clinical trials initiative at the three healthcare facilities was part of a broader effort to reduce maternal deaths from PPH through healthcare-based and community interventions.
She noted that maternal mortality rates remained a major challenge in the public health sector, with the Ministry of Health indicating that Kenya records 355 maternal deaths per 100,000 live births, adding that Postpartum Haemorrhage (PPH) had been cited as the main cause of these deaths, accounting for 25 to 45 per cent.
Dr Mugambi highlighted the need for a collaborative approach to tackle the issue, saying that they cannot allow women to continue dying from preventable conditions like PPH.
“Early detection and timely intervention can save lives, and that is why continuous refresher training programmes towards Postpartum Haemorrhage prevention and management are so critical,” the Director elaborated.
The Director made the remarks at NCRTH when she hosted officials from the World Health Organization (WHO) and the University of Nairobi, who are spearheading the landmark study.
On Postpartum Haemorrhage (PPH), Dr Mugambi affirmed that reducing deaths from childbirth-related bleeding involved strategies such as the use of Carbetocin drugs that greatly prevent PPH after mothers give birth.
This, she said, helps in quick contraction of the uterus, and calibrated delivery drapes, a clear curtain-looking paper placed on the bed where mothers give birth, to accurately measure the loss of blood.
According to medical experts, PPH usually occurs within 24 hours of childbirth, but it can happen up to 12 weeks after childbirth. When the bleeding is detected early and treated quickly, it saves the life of the mother.
They indicated that PPH happens when the total blood loss is greater than 32 fluid ounces after delivery, regardless of whether it’s a vaginal delivery or a Caesarean section, or when bleeding is severe enough to cause symptoms of too much blood loss or a significant change in heart rate or blood pressure.
Dr Mugambi explained that there were two types of PPH. Primary postpartum haemorrhage occurs within the first 24 hours after delivery. However, secondary or late postpartum haemorrhage occurs 24 hours to 12 weeks postpartum.
The joint UoN-WHO initiative also focuses on enhancing knowledge and skills of midwives, particularly those operating in low-resource settings in PPH prevention and management. It is also raising awareness about PPH within communities and advocating for policy changes to improve maternal health outcomes.
Dr Mugambi indicated that health workers need to be well versed with drape – a direct blood measurement technique which uses a BRASS-V clear curtain-looking pouch placed on the bed where mothers give birth for blood collection.
If blood loss passes the 250 ml mark, it signifies a need for control, while between 500ml-1000ml is classified as a danger zone, hence postpartum haemorrhage.
Dr Mugambi affirmed Nakuru’s dedication to evidence-informed health policies, adding that they will continue to use research data to inform decisions that lead to improved patient care and outcomes.
In 2023 the Ministry of Health and the World Health Organization recommended using the calibrated drapes to accurately measure blood loss after childbirth.
Dr Mugambi said under the training initiative they were encouraging the purchase and distribution of drapes to health facilities that offer childbirth services.
“The plan is to ensure that excessive bleeding is detected early and managed to prevent complications that arise from losing blood, like transfusion and even the death of the mother,” she stated
Head of the Department of Obstetrics and Gynaecology at the University of Nairobi Professor Zahida Qureshi is the programme’s Principal Investigator, with George Gwako, an Obstetrician/Gynaecologist listed as the second Co-Principal Investigator while Dr George Mugendi from the UoN’s Faculty of Health Sciences, Department of Pharmacy, is the study’s pharmacist.
Professor Qureshi explained that heat-stable Carbetocin presents a promising advancement in PPH management, while HSC provides prolonged uterotonic action, potentially eliminating the need for repeat dosing.
She said that PPH kills women because it is detected late and/or even misdiagnosed altogether.
He cited information gaps on potential complications that mothers experience as a key challenge in addressing maternal deaths, with a majority of the mothers reporting late.
“Early diagnosis is critical to determine what can be managed at what facility and make necessary referrals in good time to save the mothers,” said the Don.
Professor Qureshi said most healthcare providers check visually to assess bleeding, and that often tends to underestimate how much blood the mother has lost, and then treatment is delayed, leading to life-threatening consequences that could lead to the mother losing her uterus or dying.
While indicating that the findings of the REACH trials are expected to provide critical evidence to guide policy and inform future use of HSC in PPH treatment protocols, Professor Qureshi noted that the new heat-stable formulation does not require refrigeration, making it more practical for use in settings with limited cold chain storage, particularly in rural areas.
Professor Qureshi pointed out that though the World Health Organization (WHO) had added the heat-stable Carbetocin to its Essential Medicines List of uterotonics for preventing postpartum haemorrhage, the drug is still being evaluated in some clinical trials and is expected to become more widely available and used in the near future, potentially revolutionising maternal health care.
This added Professor Qureshi underscores the urgent need for an alternative uterotonic such as Heat-Stable Carbetocin that combines the efficacy of oxytocin with the storage advantages of misoprostol.
On her part, Dr Testa Dey from WHO emphasised that while HSC is currently approved for PPH prevention, expanding its use for treatment could significantly improve maternal health outcomes.
“This would particularly benefit women who receive HSC prophylactically yet still develop PPH,” she said.
A 2023 World Health Organization (WHO)-backed study that involved over 200,000 women in 80 public hospitals in Kenya, Nigeria, South Africa, and Tanzania showed that after the diagnosis, the healthcare provider offers all the treatments available within 15 minutes, and not one after another as has been the practice.
Medical experts have underscored the need to wholly change tact in Kenya to manage the deadly PPH complication by first using calibrated drapes and then giving all the treatments as a bundle of massaging the uterus, giving uterotonics (medicines to contract the womb and stop the bleeding), giving the mother intravenous fluid and having healthcare providers examine the mother to see whether there is a need for referral.
By Esther Mwangi
