Medical professionals and Civil Society Organisations across Nigeria are rallying behind the call for the widespread adoption of the World Health Organisation’s (WHO) E-MOTIVE protocol—a groundbreaking intervention aimed at reducing the alarming rate of maternal deaths caused by postpartum haemorrhage (PPH).
Postpartum haemorrhage, which WHO defines as the loss of more than 500 millilitres of blood within 24 hours after childbirth, remains one of the leading causes of maternal mortality globally. The condition claims an estimated 70,000 lives annually, particularly in low- and middle-income countries, with sub-Saharan Africa bearing a disproportionate burden. Statistics from WHO indicate that PPH contributes to around 25 percent of all maternal deaths worldwide, translating to one woman dying every six minutes.
In a significant development, a 2023 multicentre trial jointly conducted by WHO and the University of Birmingham across 80 hospitals in Kenya, Nigeria, South Africa, and Tanzania has revealed that the E-MOTIVE strategy—based on early detection and a prompt bundle of treatments—can dramatically reduce severe bleeding and improve survival outcomes. The study, published in the New England Journal of Medicine, observed over 200,000 women and demonstrated that early detection of blood loss using a calibrated drape combined with simultaneous administration of WHO-recommended interventions reduced cases of severe bleeding by 60 percent.
The E-MOTIVE approach includes a series of coordinated treatments: uterine massage, administration of oxytocic drugs, tranexamic acid, intravenous fluids, and a structured examination protocol. Unlike the conventional model where care is administered sequentially, often resulting in dangerous delays, this bundle is delivered immediately upon diagnosis of PPH.
Professor Hadiza Galadanci, Director of the Africa Centre of Excellence for Population Health and Policy (ACEPHAP) at Bayero University, Kano, where the Nigerian arm of the trial was conducted, explained that delayed detection and stepwise interventions remain the primary factors behind the high mortality rate associated with PPH. She noted that visual estimations of blood loss—the current standard in many facilities—are not only unreliable but responsible for countless missed diagnoses.
Galadanci cited data showing that over 50 percent of women with significant bleeding are not detected in time under conventional methods. She stressed that the E-MOTIVE trial was designed to address this failure in three key areas: early detection, prompt treatment, and streamlined intervention. “With E-MOTIVE, healthcare providers use the drape to objectively detect blood loss and immediately administer the full treatment package without waiting for previous steps to fail,” she said.
The success of the initiative has already started to make an impact in real-life cases. One of the beneficiaries, Mrs. Fadirah Tijani, who suffered a severe haemorrhage during her last childbirth, credited the quick response of doctors and midwives using the E-MOTIVE bundle for saving her life. “I truly feared for my life. It was unlike anything I had experienced before. But they acted swiftly and professionally. I’m grateful for that,” she recalled.
Professor Arri Coomarasamy, Co-Director of the WHO Collaborating Centre on Global Women’s Health at the University of Birmingham and lead investigator of the trial, highlighted the time-sensitive nature of managing PPH. He described the E-MOTIVE system as a potential game-changer, capable of transforming maternal health outcomes across the globe. “Delays cost lives. This approach helps eliminate those delays,” he stated.
Midwives and medical staff involved in the initiative have echoed similar sentiments. Maryam Sulaiman, a midwife with ACEPHAP, noted that the new protocol ensures all interventions are completed within 15 minutes. At Aminu Kano Teaching Hospital, E-MOTIVE Champion Binta Bello explained that a dedicated trolley stocked with all essential materials is now on standby, allowing quick deployment to any delivery ward in cases of emergency. “The moment PPH is suspected, we call for the E-MOTIVE trolley. Everything we need is in there—no time is wasted,” she said.
The Advocacy and Implementation of Maternal, Newborn, and Child Nutrition and Health (AIMNCH) project, which promotes the E-MOTIVE strategy, is being spearheaded by ACEPHAP in partnership with other stakeholders, including the ACE Network in Africa, Pathfinder International Nigeria, the Medical Women’s Association of Nigeria, and the Centre for Communication and Social Impact (CCSI). The consortium is working to strengthen the capacity of health workers while integrating PPH detection and treatment tools into Nigeria’s public health system.
Professor Galadanci further called for community-level education and collaboration with Traditional Birth Attendants (TBAs), urging that they be trained and formally integrated into the healthcare delivery system. “The TBAs are influential at the grassroots. They can play a crucial role in encouraging hospital deliveries and prompt care-seeking behaviour,” she advised.
She also stressed the importance of local radio, social media campaigns, and the engagement of religious and community leaders to help change misconceptions and traditional beliefs that hinder maternal care in rural areas. “Interactive discussions in local languages can help communities understand the risks of home births and the value of hospital-based care,” she added.
On her part, the Executive Director of CCSI, Babafunke Fagbemi, highlighted the broader socio-economic implications of maternal health. She argued that addressing maternal mortality requires more than clinical solutions. According to her, women’s education and economic empowerment are essential to improving maternal health outcomes. “Educated and economically empowered women are more likely to seek skilled birth attendants and make informed decisions about their health,” she said.
Fagbemi outlined a series of recommendations, including integrating the E-MOTIVE protocol into national health systems, improving the availability of drugs and equipment, subsidising maternal health services, and training health workers in emergency response. She also emphasised the need for continuous community engagement and stronger referral systems.
She called on government agencies, CSOs, international partners, and healthcare institutions to work collectively in adopting WHO’s evidence-based guidelines for PPH prevention and management. “By prioritising maternal health, Nigeria can make significant progress toward achieving Sustainable Development Goal 3, which aims to ensure healthy lives and promote well-being for all at all ages,” she concluded.
