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

Sunday Trust - - DISCOURSE - By Toyin Saraki

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

Toyin Saraki

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