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Maternity Care in Low Resource Settings – The art of achieving good outcomes with few resources

Based on an event called ‘Improving the Health of the Nation: An evening of presentations exploring the world’s biggest health challenges’
20/06/13

On Thursday last week I went along to a seminar session hosted by the University of Liverpool and the Medical Research Council (MRC). The MRC is the main government funding body for UK science research. The evening included a series of fantastic short presentations describing some of the MRC-funded work that’s being carried out in Liverpool.

Now, if you want to be cynical about things, it was quite a self-aggrandising exercise but that doesn’t detract from the amazing science that was described. I’ll be talking about the talks over the next few posts (before returning to silliness for the final Gremlins post!). This post describes the first talk of the evening. Enjoy!

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Maternity Care in Low Resource Settings – The art of achieving good outcomes with few resources
By Prof Andrew Weeks (Professor of International Maternal Health)

In the UK, the death rate of expectant mothers has dropped massively over the last century. Just take a look at the graph below – look at it go! Between 1890 and around 1935, the number of pregnancies ending in the mother’s death ranged from 1 in 285 to 1 in 200. When you take into account that many women have multiple children, that was an incredible 1 in 10 women!

Graph showing UK death rates in pregnant women from 1890 to 1980 (Photo Credit: Women’s Health)

The tremendous decrease in the death rate came between the mid 1930s and 1960s. There were a number of factors that contributed towards this drop, including the founding of the NHS in 1948 and the introduction into general medical practice of penicillin and other antibiotics from around the same time. Then, of course, there were the massive developments in the field of midwifery and the improvements, and increase in number, of blood transfusions.

Today in the UK, the percentage of women who develop complications during their pregnancy is very much the same as it’s ever been (around 15%) but very few die thanks to these developments in medicine. That’s because most of the improvements described focused on dealing with complications, rather than preventing them.

Now, this is all well and good for the UK, but there’s a shocking difference between figures from the UK and sub-Saharan African nations. Nigeria and Ethiopia in particular still have similar death rates to those seen in Britain prior to the 1930s. This is all because of the poor quality of healthcare in those countries.

A powerful demonstration of the differences between British and sub-Saharan African healthcare is the treatment of pre-eclampsia – that is, high blood pressure during pregnancy. It’s a very common condition, affecting 1 in 20 expectant mothers. In the UK, it is treated easily and is hardly seen as a complication really. Yet, if left untreated, it can kill. Prof Weeks described a patient he’d seen on a recent trip to Nagpur, India who had suffered from untreated pre-eclampsia. The woman had lost her unborn child and had, herself, fallen into a coma from which she would be lucky to awaken.

So why is this easily treatable condition still such a big problem in these African countries? Unfortunately, as with so many things, it boils down to money. Despite the relative simplicity of treating pre-eclampsia, it costs the NHS a whopping £5,330 to treat every single case. Now, the NHS has that money. The sub-Saharan African countries with poor healthcare don’t. A shocking example is Malawi – the health service there is afforded a mere £43 to deal with each case of pre-eclampsia!

As Prof Weeks said, it’s damn near impossible to treat people with so little money. Indeed, the World Health Organisation’s (WHO) recommended way of the delivering the baby in women with pre-eclampsia would cost the entire Malawian budget per person. That leaves no money to treat the mother, who would likely die as a result.

Sanyu Research Unit logo (Photo Credit: Electronic Product Supplies / Sanyu Research Unit / University of Liverpool)

That’s where Prof Weeks’ research group at the Liverpool Women’s Hospital Sanyu Research Unit comes in. They’re working on ways to get as much as possible out of the meagre sums of money available to these African health services. To date, they’ve looked into two potential alternatives for inducing labour, that will leave enough money to hopefully treat the mother too:

Misoprostol

This is a hormone made up of lipids, also known as a prostaglandin. It’s used to treat stomach ulcers but is not recommended for use by pregnant women, as it is capable of inducing labour. The group that looked into it realised that this side effect could in fact be turned into the main goal of Misoprostol’s use. After 15 to 20 years of research, the dose required to reliably induce pregnancies has been calculated and it is now used to do so. The great news is that it only costs £1 per course – a considerable improvement over the £43 WHO-recommended method!

Foley catheter

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A diagram of a Foley catheter (Photo credit: Wikipedia)

A Foley catheter is a paired set of rubber tubes that is more commonly passed through the urethra (the tube you urinate through) and into the bladder. Just the picture on Wikipedia makes me wince! Urine passes down one of the tubes only. There’s a small balloon at the bladder end of the second tube. Once the catheter is in place, sterile salt water is passed up the tube into the balloon, inflating it. This ensures that the catheter won’t fall out. The Foley catheter can be used to induce labour by inserting it into the cervix rather than the bladder. When the balloon is inflated, it stretches the cervix until it is the necessary size for allowing birth.

The MRC is currently funding a trial to work out whether the Foley catheter or Misoprostol is the best way to induce pregnancies. The trial, involving the University of Liverpool, the Medical College in Nagpur and Gynuity Health Projects in America, is comparing the treatments’ effectiveness in 602 women. You can read the trial proposal here – it’s a bit wordy, as these things often are, but it gives more details of the trial and the induction methods being compared.

I thought this was a really interesting overview of an area of science of which I had no prior knowledge. Prof Weeks explained things concisely, but clearly, and left the audience in doubt as to the global importance of his research. I hope you found the topic as interesting as I did!

The next post will describe the main points of a short talk about research into Biomechanics. Hope to see you then!

 
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Posted by on June 23, 2013 in Biology

 

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Becoming an Expert: Ewan Minter

Happy Monday everyone!

I just wanted to draw your attention to a feature I’ve written for a worthwhile series on the University of Liverpool’s news page. The ‘Becoming an Expert’ series describes and explains, in lay terms, the projects and findings of individual PhD students, Masters students and Postdoctoral researchers at the University. It’s a great way of making the public aware of the research that is carried out in a university, across all subjects, not just science.

The feature I wrote describes Ewan Minter’s studies into ocean acidification and the effects it will have on marine organisms over time. You can check it out at https://news.liv.ac.uk/2013/03/25/becoming-an-expert-ewan-minter/

Whilst you do that, I’ll be writing my next blog entry. This week, we’ll be tackling some Astrophysics! See you soon!

 
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Posted by on March 25, 2013 in Biology

 

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