Seven medical innovations or treatments, most of which are easy to implement and inexpensive, could significantly reduce maternal and infant mortality worldwide, particularly in sub-Saharan Africa and South Asia. This is the conclusion of the latest Goalkeepers Annual Report 2023, published this Tuesday by the Bill and Melinda Gates Foundation. “By bringing new innovations to those who need them most, two million additional lives could be saved by 2030 and 6.4 million lives by 2040,” estimates the major philanthropic company in its annual report, which focuses on maternal and child mortality rates, and their progress has stalled since 2016 and even increased in some countries, including the United States.
These innovations include rapid diagnosis of postpartum hemorrhage, an intravenous iron injection for anemia, a probiotic supplement for babies, prenatal corticosteroids (anti-inflammatory agents) for women who deliver prematurely, azithromycin (an antibiotic) to reduce infections, or a portable ultrasound Artificial intelligence device for monitoring high-risk patients in low-resource settings.
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In 2015, world leaders agreed on 17 sustainable development goals with a view to 2030. The year 2023 represents the equator, the halfway point to these goals. And in the case of mothers, children and newborns, the data suggests there is still a long way to go. The goal set at the time was to end all preventable child deaths by 2030 and reduce maternal mortality to 70 per 100,000 births. That didn’t happen. Every day 800 women die worldwide as a result of pregnancy and childbirth. That means one every two minutes. According to the United Nations, 70% of these deaths occur in sub-Saharan Africa. In addition, around five million children die before their fifth birthday every year. Nearly two million more babies die before they take their first breath: they are stillborn.
And this despite the fact that, according to the report, there has never been so much scientific knowledge about the health of mothers and children. “Researchers have learned more about maternal and newborn health in the last decade than in the entire previous century,” the report says. The problem is that the solutions are not reaching those who need them most. The authors even speak of an “epidemic of maternal and child mortality,” and not just 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 the hardest hit are black and indigenous women,” says Melinda French Gates.
In the 2000s, indicators of human well-being such as poverty and education improved significantly, and it was maternal and child health that made the greatest progress. This was possible, among other things, because several international organizations set ambitious goals, which were, however, reduced from 2016 onwards and ultimately stagnated with the outbreak of the Covid-19 pandemic. According to the report, there are countries such as Venezuela or the United States where it has even increased.
Three cost-effective lifesavers
According to Melinda French Gates, three low-cost innovations can prevent thousands of women in low- and 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 of intravenous iron Anemia.
Postpartum hemorrhage (PPH), which is the loss of more than half a liter of blood within 24 hours of birth, is the most common cause of death in mothers. The World Health Organization (WHO) estimates that it affects 14 million women annually, of whom 70,000 die, particularly in low-income countries. In poor countries, the main problem is recognizing that there is significant blood loss. This is only appreciated visually in many places and results in thousands of women dying without receiving the treatment that could save them.
The Gates Foundation suggests a simple and inexpensive way to quantify this blood loss: A birth blanket that looks like a calibrated V-shaped plastic bag is hung on the edge of the bed and the blood that falls into it rises, just as Mercury does a thermometer. It is a quick visual indicator that alerts healthcare professionals. In addition, it is suggested that the five treatments for hemostasis (uterine massage, oxytocics, tranexamic acid, intravenous fluids and genital tract examination) should not be applied sequentially, but should be grouped together. In a study called E-MOTIVE, Nigerian obstetrician and gynecologist Hadiza Galadanci and a team of researchers from four African countries with high maternal mortality rates found that this change reduced cases of severe bleeding by a remarkable 60%.
Another of the proposed changes concerns the treatment of anemia, which affects 37% of pregnant women – although it can reach up to 80% in some places in the world, such as South Asia – and increases the risk of bleeding during childbirth. Diagnosis 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 introduce a promising new intervention in her country: a one-time intravenous iron infusion Injection, which lasts 15 minutes and can replenish the woman’s iron stores.
Another major cause of maternal mortality is infection. In recent years, researchers have discovered that one of the most promising new ways to prevent infections during pregnancy is by administering one of the world’s most commonly used antibiotics during birth: azithromycin. In a study in sub-Saharan Africa, cases of sepsis (an extreme inflammatory reaction) were reduced by a third.
“These advances alone are not a panacea: they require countries to continue to recruit, train and fairly compensate health workers, 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 child health has evolved faster and further than I could have expected in my lifetime,” says Bill Gates, highlighting the launch of three Gates Foundation programs to investigate child and newborn deaths prevent: CHAMPS (Child Health Surveillance and Prevention of Mortality, in English); PERCH, which studies the causes of pneumonia in children, and GEMS, which looks at diarrheal diseases.
Ten years ago, he continues, “all records 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 sea of different diseases with dozens of different causes and treatments away; Pneumonia, for example, is associated with more than 200 types of pathogens,” Gates adds.
Data collection in recent years by taking blood and tissue samples from deceased children and comparing cases has shown that some pathogens were less likely than expected, such as the one that causes whooping cough, while others were more common. like Klebsiella, which is more difficult to treat. This new information about this last bacterium “will allow doctors to consider which antibiotics to give,” explains Bill Gates. He calls this “the baby knowledge boom.” “Thanks to studies like those from CHAMPS, PERCH and GEMS, health professionals are beginning to understand exactly when and why some babies die, thereby saving the lives of others,” he emphasizes.
Another example Gates highlights is the way doctors help premature babies breathe by giving the pregnant mother prenatal corticosteroids (ACS) when labor is expected to occur 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 nearly 400,000 by 2040.” Also reduced the provision of probiotic supplements containing bifidobacteria, bacteria that live in the digestive system and help break down lactose 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 reporting on issues of sustainable human development.
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