World Health Organisation releases list of medicines vital for saving mothers and children


Improving maternal and child health is a global priority. An estimated 8.1 million children under the age of five die every year and an estimated 1,000  women – most of them in developing countries – die every day due to complications during pregnancy or childbirth. 

Many of these deaths are due to conditions that could be prevented or treated with access to simple, affordable medicines. However, the availability of medicines at public-health facilities is often poor. 

This  list  of  Priority  Medicines  for  Mothers and Children was developed by the World Health Organization and UNICEF to help countries and partners select and make available those medicines that will have the biggest impact on reducing maternal, newborn and child morbidity and mortality.


Contact
World Health Organization Department of Essential Medicines and Pharmaceutical Policies
Email: pedmeds@who.int
Department of Maternal, Newborn, Child and Adolescent Health
Email: mncah@who.int


Priority medicines for mothers and children 2011 WHO/EMP/MAR/2011.

1. Priority medicines for mothers

Post-partum haemorrhage
Obstetric haemorrhage is the world’s leading cause of maternal mortality causing an estimated 127,000 maternal deaths annually. Postpartum haemorrhage is the most common type and studies suggest that it may cause up to 50% percent of all maternal deaths in developing countries.
Oxytocin: 10IU in 1-ml ampoule
Sodium chloride: injectable solution 0.9% isotonic or Sodium lactate compound solution– injectable (Ringer’s lactate)

Severe pre-eclampsia and eclampsia
Pre-eclampsia and eclampsia are major health problems in developing countries. Every year, eclampsia is associated with an estimated 50 000 maternal deaths worldwide.
Calcium gluconate injection (for treatment of magnesium toxicity): 100 mg/ml in a 10-ml ampoule
Magnesium sulfate: injection 500mg/ml in a 2-ml ampoule, 500mg/ml in a 10ml ampoule

Maternal sepsis
Infection can follow an abortion or childbirth and is a major cause of death. Sepsis that is not related to unsafe abortion accounts for up to 15% of maternal deaths in developing countries. The majority of unsafe abortions take place in developing countries.
Ampicillin: powder for injection 500 mg; 1g (as a sodium salt) in vial
Gentamicin: injection 10 mg; 40 mg/ml in a 2-ml vial
Metronidazole: injection 500mg in a 100-ml vial
Misoprostol: tablet 200µg

Sexually transmitted infections 
Nearly a million people acquire a sexually transmitted infection, including the human immunodeficiency virus (HIV), every day. After pregnancy-related causes, sexually transmitted infections are the second most important cause of healthy life lost in women. The results of infection include acute symptoms, chronic infection, and serious delayed consequences such as infertility, ectopic pregnancy, cervical cancer, and the untimely deaths of infants and adults. Many sexually transmitted infections affect the outcome of pregnancy and some are passed to unborn and newborn babies.

  • Uncomplicated genital chlamydial infections:
Azithromycin: capsule 250mg; 500mg or oral liquid 20mg/5ml
  • Gonococcal infection – uncomplicated anogenital infection:
Cefixime: capsule 400mg
  • Syphilis:
Benzathine benzyl penicillin: powder for injection 900mg benzyl penicillin in a 5-ml vial; 1.44g benzyl penicillin in a 5-ml vial.

Preterm birth 
The incidence of preterm birth is approximately 6–7% of all births. Preterm birth is the leading cause of neonatal mortality both in developed and developing countries, accounting for an estimated 24% of neonatal deaths.
Betamethasone: injection 5.7 mg/ml as betamethasone sodium phosphate 3.9mg (in solution) or betamethasone acetate 3mg (in suspension) in an aqueous vehicle or Dexamethasone – injection 4 mg dexamethasone phosphate (as disodium salt) in 1-ml ampoule
Nifedipine: immediate release capsule 10mg

2. Priority medicines for children under five years of age

Pneumonia 
Pneumonia is the single biggest cause of death in children, killing an estimated 1.6 million children under the age of five years annually and accounting for 18% of all deaths of children under five years old worldwide.
Amoxicillin: dispersible, scored tablets 250mg and 500mg or equivalent flexible oral solid dosage form, in blister packs of 10
Ampicillin: powder for injection 500mg and 1g
Ceftriaxone: powder for injection 250mg and 1g
Gentamicin: injection 20mg/ml
Oxygen: medicinal gas
Procaine benzylpenicillin: powder for injection 1g and 3g

Diarrhoea 
Diarrhoeal disease is the second leading cause of death and a leading cause of malnutrition in children under five years old, killing more than 1.3 million children every year.
Oral Rehydration Salts (ORS): sachets of 200ml; 500ml and 1 litre, appropriate flavour
Zinc: 20 mg scored dispersible tablet or equivalent flexible  oral solid dosage form

Malaria 
Every 45 seconds a child dies of malaria in Africa. In 2008, there were 247 million cases of malaria and nearly one million deaths – mostly among children living in Africa. Artemisinin combination therapy (ACT): strengths and combinations according to WHO treatment guidelines 2010, dispersible tablet or flexible oral solid dosage form and dose optimized
Artesunate: rectal and injection dosage forms 50–200 mg 

Neonatal sepsis 
One quarter of the estimated 3.6 million neonatal deaths around the world each year are caused by severe infections, and around 528 000 of those are due to neonatal sepsis alone.
Ceftriaxone: powder for injection 250 mg and 1 g
Gentamicin: injection 20 mg/ml
Procaine benzylpenicillin: powder for injection 1g and 3g

HIV 
An estimated 2.1 million children were living with HIV at the end of  2008, 1.8 million of them in sub-Saharan Africa. Most infections are  the result of transmission from mother to child. Without effective  treatment, an estimated one third of infected infants will have died by one year of age, and about half will have died by two years of age.
Standard regimen for first-line anti-retroviral treatment: 1 non-nucleoside reverse transcriptase inhibitor plus 2 nucleoside reverse transcriptase inhibitors such as the fixed dose combination of lamivudine + nevirapine + zidovudine – tablet 30mg + 50 mg + 60 mg; 150 mg+ 200 mg + 300 mg 
For treatment of specific  populations,  see the latest WHO treatment guidelines

Vitamin A deficiency 
Vitamin A deficiency is a recognized risk factor for severe measles. An estimated 164 000 people died from measles in 2008 – mostly children under the age of five.
Vitamin A: capsule 100 000 IU strength; 200 000 IU strength
Palliative care and pain 
Although means to relieve severe pain are widely available, their use in children is often limited.
Morphine: granules 20 mg, 30 mg, 60 mg, 100 mg, 200 mg, injection 10 mg/ml, oral liquid 10 mg/5 ml, variable flexible oral solid dosage forms
Paracetamol: variable flexible oral solid dosage forms .


World Health Organization 2011. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for  damages arising from its use.
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