A global study titled WOMAN-2 suggests anaemia, not excessive bleeding, may be the primary underlying cause of maternal deaths in sub-Saharan Africa and South Asia. The research, conducted by The Woman Trials, found that anaemia could be responsible for up to half of severe postpartum haemorrhage (PPH) cases in these regions. The study examined over 15,000 women with moderate or severe anaemia during childbirth in Nigeria, Pakistan, Zambia, and Tanzania. It revealed that women with severe anaemia were twice as likely to be diagnosed with PPH even after losing less than 500ml of blood, challenging the standard method of diagnosing PPH based on blood loss alone. The report, published on Wednesday, argues that anaemia significantly increases the risk of shock and organ failure even after moderate bleeding. It states that measuring blood loss is not accurate in identifying high-risk women, especially those already anaemic. The study calls for new diagnostic criteria that include maternal haemoglobin levels, haemodynamic instability, and other risk factors. Nigeria, where the maternal mortality ratio is 1,047 deaths per 100,000 live births according to the World Health Organisation, accounts for about a quarter of global maternal deaths. The 2023 WHO roadmap to combat PPH did not include these findings, as they were not yet available, leaving anaemia's role unaddressed in current global strategy. The report warns that administering intravenous fluids to anaemic women without confirming haemorrhage can lead to fluid overload, a leading cause of transfusion-related deaths.
The WHO's 2023 PPH roadmap targets bleeding as the main enemy, yet the WOMAN-2 study shows anaemia may be the real driver of death — a misalignment that puts Nigerian women at greater risk. With Nigeria accounting for a quarter of global maternal deaths and severe anaemia doubling PPH diagnoses even with minimal blood loss, current protocols may be misdiagnosing and mistreating women. Relying on blood loss alone ignores critical signs like haemoglobin levels, potentially leading to harmful fluid overload in anaemic mothers. This gap between policy and evidence could be costing lives in Nigerian delivery rooms.
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