Earlier this year Devex published an interesting article titled ‘Tackling the hidden cause of maternal mortality in Nigeria’. The article zoomed into one factor that was contributing to high maternal mortality rates. It wasn’t the capacity of health care worker or facilities. It was however and still is the quality of medicines such as oxytocin. In Nigeria, almost 75% of oxytocin was found to be of substandard quality.
Nigeria is not alone. This editorial has added to the growing number of articles that have recently been published on the substandard quality of medicines in low and middle income countries.
Oxytocin is one of the key drugs in managing postpartum haemorrhage and is included in the WHO list of essential medicines. However, oxytocin is a difficult drug to manufacture, supply and store, as it is only stable in cool temperatures and it is easy to break the cold chain. Even though oxytocin is part of the essential medicine list, there is limited guidance for healthcare workers as to how it should be stored. Even when there is guidance, it varies from country to country. Furthermore, current administration of the drug is either via the intramuscular route (injection into muscle) or intravenous route (injection into a vein), which requires skilled healthcare providers, clean needles for administration, and measures to ensure safe disposal.
Maternova has been closely following a new way of administering oxytocin which could revolutionize the way in which postpartum haemorrhage is managed in the developing world. Since 2011, the Monash Institute of Pharmaceutical Sciences’ has invested significantly into developing an inhaled form of oxytocin through an inhaler, very much like the inhalers used by asthma patients. Currently, inhaled oxytocin has entered phase 1 clinical trials on healthy non-pregnant women, supported by the large British pharmaceutical company GlaxoSmithKline. Although the trial was small, results have been positive so far showing no serious side effects, and the drug was well tolerated. Furthermore, inhaled oxytocin showed a similar absorption and elimination profile to the intramuscular route, which is reassuring. The fact that inhaled oxytocin showed no significant differences in comparison to the injectable form now means that less extensive trials are required for a completely new drug. Larger phase 1 trials are now needed, to focus more on effectiveness.
Inhaled oxytocin has shown to be a reliable route for administration in comparison to other routes as it allows for rapid absorption - crucial during haemorrhage when women can lose liters of blood in a very short amount of time. It also shows more heat stability in comparison to other forms, and can withstand tropical conditions for a significant amount of time.
There are various other oxytocin product innovations under way. However, if oxytocin can be produced in a heat stable form, and the need for a needle to administer it is removed, then there is no reason why all women cannot have access to this drug. The inhaled form of oxytocin captures these qualities and therefore has the ability to save an additional 20,000 pregnant women each year.
By Shreya Patel
Photo credit: By robin_24 - https://www.flickr.com/photos/robin24/5222119114/in/photostream, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=16419735
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.