The Sustainable Development Goals will not be achieved. In 2015, all countries in the world agreed on 17 major targets to be achieved to end poverty, fight against inequalities and injustices, and deal with climate change by 2030. But the pandemic, economic tensions and the war in Ukraine have shaken up this agenda. As the United Nations prepares to take stock of the progress accomplished at its annual general assembly on September 18 and 19 in New York, the outlook looks gloomy. “This is not going in the direction we would like,” summarizes Marc Suzman, director of the Bill and Melinda Gates Foundation, which plays a leading role in financing global health programs.
This is why the Foundation, on the occasion of the publication this Tuesday, September 12 of its annual report, Goalkeepers, has chosen to focus on one of the objectives that seems most crucial to it: maternal and child health. . “From 2000 to 2015 [NDLR : durant la première période des objectifs du millénaire pour le développement], we have seen huge advances in this area. The number of preventable child deaths has fallen from 10 million per year to 5 million. But since then, this progress has initially slowed down, before stopping”, regrets Marc Suzman. In a way, the results obtained at the beginning of the 2000s were the easiest to achieve: they are very largely linked to the dissemination of vaccines against rotaviruses which cause diarrhea, and against pneumococci which cause pneumonia.
To go further, we must now tackle other common causes of death of young mothers and their children. First, by fighting against postpartum hemorrhage and infections among mothers, because “when a woman dies at the time of birth, the chances of her baby reaching its first birthday decrease by 37%,” notes Bill Gates. and Melinda French Gates in the introduction to the report. Then, by protecting the health of newborns, again from infections, but also from the effects of prematurity and malnutrition.
A well-demonstrated benefit
The good news is that inexpensive tools exist to prevent these scourges. The Gates Foundation listed them, and largely financed the work necessary to provide scientific demonstration of their effectiveness. Thus, when a hemorrhage occurs at the time of birth, a set of combined measures makes it possible to reduce mortality by 60%, according to a study carried out on 200,000 young mothers. To do this, delivery beds must be equipped with a plastic sheet with a pocket at the end, where the blood drains. This way, caregivers can better assess the quantities lost and act accordingly. In the event of excessive losses, it is appropriate to combine the five existing treatments (uterine massage, medications promoting uterine contractions and stopping bleeding, etc.) instead of using them sequentially.
Better still, scientists now know how to avoid a large part of these hemorrhages: by preventing anemia. This lack of iron in the blood affects on average 37% of women worldwide, and up to 80% in South-East Asia. It increases the likelihood of significant bleeding during childbirth. Even worse, by reducing the quantity of oxygen transported, it increases the risk of dying for the same volume of blood lost, compared to non-anemic women. To avoid it, however, it is enough to administer iron supplementation throughout the pregnancy, in the form of tablets. But these medications can have some undesirable effects, or prove difficult to access, particularly in developing countries.
In Nigeria, Professor Bosede Afolabi, researcher and head of the maternity ward at Lagos hospital, had the idea of testing the administration of iron in one go, by an intravenous injection. She showed that this gave parturients a sufficient reserve for their entire pregnancy and even after, while effectively treating the most severe anemia. The effect would even be beneficial in the longer term, on the child’s neurodevelopment. “Compared to simple tablets, an intravenous injection may seem more expensive. However, we believe that it will prove effective, because the treatment of anemia generally involves blood transfusions, which are themselves expensive, but also more risky “, indicated Professor Afolabi during a press conference organized by the Gates Foundation. Furthermore, iron supplements in tablet form remain insufficient in cases of severe deficiency. “But these are probably the cause of most deaths,” underlined Victor Akelo, public health specialist for the Centers for Disease Prevention and Control (CDC), based in Kenya, during the same press briefing. .
Accelerate lung maturation
The second major challenge remains infection prevention. Here too, a simple treatment, the administration during labor of a very common antibiotic, azithromycin, could save many mothers. A trial in sub-Saharan Africa showed that the drug reduced cases of sepsis by a third. “This is a remarkable discovery, which would be very useful in countries where most births take place at home, but also in the United States, where sepsis causes 23% of maternal deaths,” notes the report. Better still, the drug, by passing into breast milk, will also protect the newborn.
Solutions also make it possible to improve the survival of premature babies. By equipping doctors with portable ultrasound systems, it is possible to identify women most at risk of experiencing premature birth. In this case, one or two injections of corticosteroids will accelerate the lung maturation of the fetus, and limit respiratory distress after birth. Epidemiologists at the Gates Foundation estimate that by making this treatment accessible in countries in sub-Saharan Africa and South Asia, 144,000 babies would be saved by 2030, and 400,000 by 2040.
A call to financiers
And this is nothing compared to what recent discoveries on the microbiota could provide. “Various studies have shown that a death, following pneumonia for example, is always linked to a chain of events. The starting point is often malnutrition,” notes Bill Gates in his report. However, scientists have recently understood that if a newborn does not have good bacteria in his intestinal flora, he will not benefit from his food, even if it is of good quality and in sufficient quantity. It is therefore now recommended to give babies, especially if they are premature or underweight, probiotics based on bifidobacteria. It would be even more useful to offer these supplements to mothers during pregnancy – in this case, babies would gain an extra five grams per day until they are born. This may not seem like much, but anything that can prevent a newborn from having too low a birth weight is valuable, because this is also a factor of vulnerability to illness.
A handful of old medications, probiotics, portable ultrasound machines… These simple solutions, with well-demonstrated benefits and relatively low cost, could save 2 million lives by 2030 according to calculations by experts at the Gates Foundation. However, they remain poorly accessible to the populations who need them most. The report is therefore intended to be an alarm for funders of health programs around the world. “These protocols must be integrated into healthcare systems. And for this, the countries concerned must increase the budgets devoted to health, and major international donors must mobilize,” recalls Marc Suzman. We will meet on September 18 and 19 at the UN to find out if the message has been heard.