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Maternal mortality in sub-Saharan Africa: A few tablets will save lives

Many lives in sub-Saharan Africa could be saved if women were given a simple course of tablets during pregnancy. The tablets, including iron and calcium supplements and anti-malarial drugs, would prevent a range of diseases which occur in the weeks immediately following childbirth. These diseases, such as anaemia, infection and hypertension, can prove fatal to new mothers.

Until now little progress has been made in reducing mortality in new mothers in sub-Saharan Africa, despite the Millennium Development Goal committed to halving maternal deaths worldwide by 2015. The current strategy focuses on providing more trained midwives and specialist care for complications in childbirth. However, the poorest countries do not have the finances to train or to pay midwives and obstetricians in sufficient numbers over the next decade. Moreover, an increasing proportion of maternal deaths are caused by infectious disease, particularly in sub-Saharan Africa.

The London School of Hygiene and Tropical Medicine and the University of Bristol, in the UK, carried out research into the effectiveness of offering all women drugs during pregnancy, irrespective of their health or social position. The research was based on data collected from systematic reviews and controlled trials looking at maternal health in Africa. The data was then fed into a model-based analysis to estimate the effect of the various interventions.

The research found that an effective course of tablets could be supplied by health clinics or by health workers within the community. An outreach programme providing tablets which can be taken in the home is very important because 25 percent of women never attend health clinics during pregnancy. Other findings included the following.

Calcium supplements reduce the risk of hypertension (high blood pressure) in women whose diets lack calcium. In severe cases, hypertension can lead to death.
Women whose diets lack iron suffer from anaemia during pregnancy. The World Health Organization recommends iron supplements to pregnant women as routine.
Malaria is another cause of severe anaemia in women during their first and second pregnancies. Anti-malarial drugs would therefore prevent anaemia, as well as malaria, in pregnant women.
Anti-bacterial drugs prevent endometritis, an infection of the lining of the womb, and other life-threatening infections.

Other causes of death in new mothers, such as haemorrhage, problems in labour, abortion and HIV/AIDS, cannot be prevented by a simple course of tablets. Nevertheless, the research estimated that the tablets would reduce maternal mortality by eight percent. Out of the 250 000 mothers who currently die following childbirth each year in sub-Saharan African, the study estimates that 19 000 deaths would be prevented.

As well as improving the mother’s health, the course of tablets would improve the baby’s health and chance of survival. Treating anaemia, malaria and pre-eclampsia (or hypertension) in women would lead to higher birth weights and fewer premature babies. Treating sexually transmitted infections in mothers would prevent stillbirth or the death of newborn babies caused by syphilis and other infections.

The study recommends the following.

A simple course of tablets is made available at health clinics and distributed by health visitors within the community.
If women take the tablets at home they will need some supervision to ensure they keep to the programme.

Source(s):
‘Could a Simple Antenatal Package Combining Micronutritional Supplementation with Presumptive Treatment of Infection Prevent Maternal Deaths in sub-Saharan Africa?’ BMC Pregnancy and Childbirth 7:6, by Simon Collin and Rebecca Baggaley, 2007 Full document.

Funded by: UK Department for International Development

id21 Research Highlight: 05 June 2008

Further Information:
Simon Collin
Department of Social Medicine
University of Bristol
Canynge Hall
Bristol
BS8 2PR, UK

Tel: +44 117 928 7279
Fax: +44 117 928 7325
Contact the contributor: simon.collin@bristol.ac.uk

Department of Social Medicine, University of Bristol, UK

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