‘Three pills and a gel’, saving the lives of women, babies

With only about two percent of the world’s population, Nigeria ranks second highest in the world for rates of maternal deaths which translates to a disturbing 13% of the global burden. Globally, nearly three million newborns die each year. Nigeria, with a population of over 170 million, houses the continent’s highest number of newborn deaths […]

With only about two percent of the world’s population, Nigeria ranks second highest in the world for rates of maternal deaths which translates to a disturbing 13% of the global burden. Globally, nearly three million newborns die each year. Nigeria, with a population of over 170 million, houses the continent’s highest number of newborn deaths as more than250,000 babies die in their first month of life every year, accounting for more than a third of all under-five deaths. 
Still, evidence reveals that 1-in-5 women, equivalent to over one million births in Nigeria, are completely alone and unassisted when they deliver their children, whether for cultural or logistical reasons. This common practice leaves women defenseless against birth complications and trauma with many dying from excessive blood loss.
From the last three Nigeria Demographic and Health Surveys (NDHS 2003, 2008 and 2013), the negative trend is rooted in human resource shortages, skill gaps amongst health workers, inadequate policy backing and the non-availability of life-saving newborn health commodities.
 Nosakhare Orobatan, Chief of Party, USAID’s TSHIP Project noted that the high death rate among newborns is partially the result of harmful traditional practices in umbilical cord care.
He said: “For generations, hot compress, charcoal, cow dung and other droppings have been applied on newborns’ umbilical cord stumps after birth, causing rather than preventing infections. To reverse this negative tide, Nigeria supported by donors such as USAID through its flagship Targeted States High Impact Project (TSHIP) is set to increase the use of high-impact integrated maternal, newborn and child health and family planning/reproductive health interventions. TSHIP is implemented by John Snow Research & Training Institute, Inc. (JSI) and partners.
Orobatan pointed out that one of TSHIP’s most promising interventions involves pioneering a two-medicine initiative that uses culturally-appropriate, low-tech and high-impact methods to protect both mother and newborn during and after birth. “The first medicine, misoprostol, is for the mother to take immediately after delivery. Just three orally ingested pills prevent PPH. A second, chlorhexidine (CHX), is an easy-to-use antiseptic to replace traditional umbilical cord care.”
“Originally produced for infant use in Nepal, the gel is applied on the newborn’s cord stump within an hour after birth, sealing the wound, preventing bacteria from latching on the cord, and allowing it to heal. When used together, misoprostol and CHX offer critical protection to both mother and child in the delicate hours of childbirth; what is commonly referred to as the ‘golden hour’,“ Orobatan said
“In line with numerous indigenous and international researches, keeping the newborn’s umbilical cord clean with CHX can reduce the risk of infection and death by up to half. Nigeria, adopted the use of CHX for newborn cord care at the 56th National Council on Health meeting in 2013.
“TSHIP is a multi-year project aimed at strengthening healthcare delivery in the northern Nigerian states of Bauchi and Sokoto. The project is working to establish strong and durable bonds between community institutions and the health care delivery system to improve household health practices and increase people’s use of health services.”
With the support of USAID through TSHIP, Sokoto State government launched its procurement of two lifesaving drugs since March 2013. It is the first government in Africa to launch the use of CHX. Later that year, Bauchi State emulated this action also with TSHIP’s assistance. State by state, Nigeria is procuring and distributing the drug pair – misoprostol and CHX – to help save the lives of mothers and their newborns. The lessons being learned in Bauchi and Sokoto, where health indices are amongst Nigeria’s least favorable, are already informing programmes and policy at the national level.
These lessons include the need to promote partnerships, engender inclusion, leverage on existing platforms (e.g. faith-based groups and community-based distribution systems), engage the policy process, ensure funding commitments, plan for integration and leverage resources from other programs.
Sokoto’s initial order of misoprostol and CHX alone meant that up to 2,250 newborn deaths due to cord infection and up to 1,000 maternal deaths due to postpartum hemorrhage were averted.
Nosakhare Orobatan  revealed that presently, 95% of all births in Sokoto take place at home; the ability to deliver such lifesaving, low-cost drugs to women in their homes is therefore critically important.
According to him so far, delegations from 31 of 36 Nigerian states plus the Federal Capital Territory, Abuja, who represent 123 million Nigerians; have undertaken study tours of Sokoto’s programme.
Nigeria gave approval to a local company -Drugfield Pharmaceuticals Limited – who began manufacturing CHX in March 2014. In February 2015, a second firm – Tuyil Pharmaceutical Industries Limited – received approval to start producing CHX. Between these two firms, Nigeria’s production capacity of CHX has gone from none in January 2014 to one with an annual production capacity of 60 million tubes as of January 2015. 
Bauchi, Sokoto and six other states have since launched their own programmes. Other states have included CHX procurement in their drugs for free health services while some have created budget lines in their 2015 budget. A major national programme procured 290,000 tubes of CHX and the United States Government made a generous donation of 200,000 tubes to ensure that there are no supply shortfalls as Nigeria regularises its production and distribution systems for CHX.
Furthermore, Drugfield has also begun exporting CHX to Haiti and Kenya.
The other medicine in the drug pair – Misoprostol – has been readily available locally in Nigeria. Working through a Public-Private and People Partnership (PPPP) Model, TSHIP is setting the stage for sustainable local production by shaping the local market under applicable drug laws. Having learned from other country experiences, this is being achieved through the generation of local evidence, assisting state governments with forecasting and quantification, sending market signals to local manufacturers and promoting the benefits of the two drugs through an aggressive advocacy and media strategy aimed at increasing demand.