Why drug trial for women is close to my heart
It is my hope that the ground-breaking tranexamic acid will mark a new era in maternal care around the globe, and that its positive impact can be matched, through heightened investment and commitment to the cause. The drug provides hope to thousands of wo
The issue of maternal and newborn mortality is one close to my heart. I tragically lost one of my twin babies during childbirth, and then had to fight for the survival of the other. In fact, I am an example of both what can go wrong when there is a delay and of the success of modern medicine. Even though I was an educated and informed woman, I was unable to save the life of my second twin daughter due to the infrastructural deficiencies in Nigeria’s healthcare system at the time. I had to wait to find an anesthetist for an emergency C-section - a delay that cost me my daughter’s life. It is however thanks to modern medicine that I was lucky to survive with one healthy child. This mission for improving maternal health is what has brought me here today and is why I am so passionate about finding interventions, such as tranexamic acid, which can save the lives of mothers.
In the developed world, death during childbirth is rare - in fact the average maternal mortality ratio in OECD countries is just 11 deaths per every 100,000 births. Sadly, this is not the case everywhere. Although in Europe, maternal mortality is a nearnegligible figure, in Sub-Saharan Africa, the risk of maternal mortality remains painstakingly high. In Nigeria, for example, the country of my birth, a woman incurs a 1 in 23 risk of dying during child birth in her lifetime. In Chad, with the highest maternal mortality ratios in the world, this figure is closer to 1 in 17. It is countries such as these that can benefit the most from tranexamic acid.
Tranexamic acid works by clotting a woman’s blood, reducing the risk of death by PPH by a third. A drug as cheap and effective as tranexamic acid therefore provides a rare opportunity for continental divides to converge - by preventing a third of PPH deaths worldwide (of which a shocking 99% are from Sub-Saharan Africa), we are a significant step closer to fair and equal maternal care around the world. The trial results speak for themselves. Over 20,000 women were enrolled in this trial, which took place in 21 diverse geographical settings, including countries with some of the highest mortality rates and absolute numbers of maternal deaths globally1. I thank the trial organisers for including such a diverse cross section of countries. As I mentioned before, maternal mortality affects those in developing countries the most and to have the trial focused in countries such as my own is incredibly important.
The administration of the drug can be the importance between life and death; as we have heard this evening, when administered to women experiencing postpartum haemorrhage (or PPH) (which affects around 6% of births) the drug can lower the amount of blood lost by mothers, and was shown to reduce maternal deaths from PPH by a 30%. What’s more, the drug is already readily available, and costs just $3 per injection.
Clearly, if administered across Africa, the health outcomes would be immense and would lead to lives of thousands of women across Africa being saved.
But this will not be easily achieved and we can expect challenges along the way.
Firstly, funding. The drug has been shown to be inexpensive and excellent value for money. However given the competitive health funding agenda in Nigeria and across Africa it is becoming increasingly difficult to secure funds for interventions, especially where Ministries of Health have funding constraints and other health demands. To combat this, we need to look elsewhere and to form strategic partnerships to secure funding sources.
We also need to consider how women access the drug and how it is administered. In my country Nigeria, many women give birth at home or in poorly equipped and under resourced medical facilities. Investigators acknowledge that most maternal deaths occur in low-resource settings, either at home or in poorly resources health facilities where intravenous administration may not be available. I believe that by commissioning further study into the administration of this drug we can investigate whether there are viable alternatives that can be used in rural and remote settings. Another option is strengthening healthcare facilities in these communities. I have seen first-hand the impact of strengthening these facilities, allowing women who would often have to