CRIBS Global Projects Overview
Capacity building, Research, Innovation, Building maternity systems
Funding: NIHR National Institute for Health Research
Where: Sierra Leone
Principal Investigators: Professor Andrew Shennan (UK), Professor Sahr Gevao (SL)
Aims: Simple, scalable innovations & research capacity building to improve maternal and perinatal health in Sierra Leone
Projects
- CRADLE-5 – national scale up of the CRADLE device and training (effectivenessimplementation randomised controlled trial) 2YoungLives – feasibility randomised controlled trial of peer mentoring intervention for teenage mothers
- APRICOT – Assessment of Point-of-care cReatinine testing In pregnancy: a feasibility COhort sTudy in Sierra Leone.
- PINEAPPLE – PlGF IN EArly Pre-eclampsia Prediction in Sierra Leone – a blinded observational cohort.
- SIPHRE – Shock Index in Pregnancy: Haemorrhage and sepsis Risk Evaluation. Shock index as a predictor of adverse outcome in maternal haemorrhage and sepsis.
2YoungLives
Saving young lives in Sierra Leone. Mentoring for healthier and safer pregnancy and birth.
Funding: NIHR National Institute for Health Research
Where: Sierra Leone
Principal Investigators: Prince Tommy William (Sierra Leone), Mangenda Kamara (Sierra Leone), & Lucy November (UK)
Aims: Locally designed community-based mentoring intervention
- Peer mentor pregnant under-18s from pregnancy to 1-year post-birth
Objectives
- Reduce maternal mortality
- To explore community attitudes to teenage pregnancy
- Facilitate safe and respectful antenatal care
- Train peer mentors to support pregnant teenagers in navigating antenatal care, promote health-seeking behaviour, provide practical parenting/childbirth/contraception advice, re-establish family connections where safe/appropriate, encourage mentees to continue/return to education or start vocational training with bursaries, support small start-ups
- Promote self-efficacy, emotional well-being, and empowerment among pregnant teenage girls (i.e. small business start-ups)
PAPAYA
PregnAncy screening Programme: Assessment of feasibilitY, Acceptability, and complex intervention development
Funding: Fetal Medicine Foundation
Where: Sierra Leone
Principal Investigators: Dr Kate Bramham (UK), Dr Alex Ridout, & Dr Awol Yemane (Sierra Leone)
Aims: Early antenatal uptake, feasibility/acceptability of risk factor-based screening and point-of-care (POC) testing
- Evaluate impact of community sensitisation/outreach intervention on early antenatal care attendance, assess feasibility of risk factor-based screening and point-of-care biomarkers
Objectives
- To assess the impact of community sensitisation/engagement on the uptake of early antenatal care attendance
- To evaluate the incidence of pre-eclampsia and maternal risk factors using history-taking alone, compared with POC screening, to assess prevalence of undiagnosed cardiovascular disease and risk factors
- To evaluate the feasibility and acceptability of screening for preeclampsia risk using novel POC Glycosylated Fibronectin and Placental Growth Factor testing in pregnant women with women, healthcare workers and community members
- To explore the feasibility of a future novel screening algorithm for prediction of preterm pre-eclampsia before 16 weeks (utilising maternal factors, mean arterial pressure, POC ultrasound (AI-enhanced) for Gestational Age, and adapted POC biomarkers) and implementation of aspirin intervention.
CRADLE-SMART
Community empoweRment Approaches to Develop Local, Early Sustainable MAteRnity care with codeveloped Technology
Funding: Foreign and Commonwealth Office
Where: Sierra Leone, Zambia, South Africa
Principal Investigators: Professor Andrew Shennan & Dr Kate Bramham (UK)
Aims: Product innovation, implementation, integration/capacity strengthening
- Reducing digital divide by fostering novel collaborations across government, private sector and civil society
- Co-designing multilingual interfaces which provide culturally targeted health information by collaborating with underserved communities, women and girls during digital user experience testing to prioritise digital inclusion and supporting women and girls to participate safely and meaningfully in the digital world
- Building local capacity to develop and apply AI responsibly with partners from The George Institute.
- Adapting pre-trained Large Language Models to aid community health workers in delivery of quality maternal care (SMARThealth), develop Butterfly IQ+ (AI point-of-care ultrasound)
PAPAGAIO
Preterm pre-eclAmpsia: PIAcental Growth fActor testing for reduction of adverse Outcomes
Funding: NIHR National Institute for Health Research
Where: Sierra Leone, Zambia, India, Brazil
Principal Investigators: Professor Andrew Shennan (UK) & Dr Leandro de Oliveira (Brazil)
Aims: Diagnosis, cost effectiveness, sustainability
Research Questions
- What are the existing care pathways for preeclampsia in LMICs, what facilitators/barriers exist to PIGF testing?
- Is PIGF testing clinically and cost-effective in reducing adverse maternal/perinatal outcomes in women with suspected preterm pre-eclampsia in LMIC settings?
- Is planned early delivery, informed by PIGF testing, clinically and cost-effective in reducing adverse maternal/perinatal outcomes in women with late preterm preeclampsia in LMIC settings?
Objectives
- Describe care pathways for preterm preeclampsia, identify barriers to, and facilitators of PIGF testing in LMICs
- Assess clinical and cost-effectiveness of PIGF testing in suspected preterm pre-eclampsia
- Evaluate clinical and cost-effectiveness of planned early delivery in late preterm preeclampsia with diagnosis incorporating PIGF testing
- Sustainably build local research capacity at individual and institutional levels
CRADLE-B
Community-based Research for Assessment, Detection, and Management of hypertension after pregnancy for LifetimE Benefit
Funding: NIHR National Institute for Health Research
Where: Sierra Leone, Zambia, South Africa
Principal Investigators: Dr Kate Bramham (UK) & Professor Bellington Vwalika (Zambia)
Aims: Culturally applicable intervention, detection, improved outcomes, capacity
- Co-develop and evaluate a targeted, community-based postnatal intervention for women with hypertensive disorders in pregnancy (HDP) to facilitate earlier detection, BP reduction and prevention of hypertension-mediated-organ-damage
Objectives
- Establish community partnerships and mapping to inform design, delivery, and dissemination of community-led interventions
- Undertake a multi-national longitudinal cohort study of women with previous/current HDP to assess prevalence. Chronic hypertension (CHT) onset and burden of hypertension-mediated-organ-damage with point-of-care testing and inform trial design
- Undertake a type-2 hybrid implementationeffectiveness trial of a co-developed intervention addressing knowledge, access and trust for women with HDP
- Strengthen local research capacity at individual and institutional levels
EMPOWERED
Early Monitoring of POstnatal WomEn to REduce risk of chronic kidney Disease: A mixed-methods observational feasibility study
Funding: King’s Health Partners
Where: Sierra Leone and Zambia
Aims: Reducing the risk of kidney disease, and feasibility of interventions
- Assess the feasibility of early interventions to reduce the risk of kidney disease in women following a pregnancy complicated by preeclampsia in lower- and middle-income countries
Objectives
- Assess the feasibility of performing point-of-care ultrasound (POCUS) fluid balance assessments for women with pre-eclampsia
- Assess the ability of different POCUS measurements to predict fluid responsiveness, fluid tolerance, and acute kidney injury in women with pre-eclampsia
- Estimate the proportion of women who have kidney dysfunction (KDIGO criteria) following pregnancies complicated by pre-eclampsia in low-income settings at 6 weeks, 3 months, and 6 months after birth
- Community engagement strategies to increase awareness of kidney health in pregnancy and improve postnatal follow-up
- Explore acceptability of early postnatal therapeutic interventions (i.e. salt reduction and anti-hypertensives)
- Shared-decision making based on understanding of pre-eclampsia, delivery, and follow-up
CARES
Cardiometabolic Adolescent REproductive health in Sierra Leone: Assessing Underlying Cardiometabolic Mechanisms in Adolescents with Pre-eclampsia
Where: Sierra Leone
Principal Investigators: Professor Andrew Shennan (UK), Dr Antonio de Marvao, Dr Kate Bramha, Dr Alexandra Ridout & Dr Candace Beoku-Betts (UK)
Aims: Cardiovascular and metabolic mechanisms of elevated risks of pre-eclampsia among adolescents
- Comparing adolescents and adults with preeclampsia to normotensive controls
- Investigate longitudinal differences in blood pressure, cardiac output, and vascular resistance
- Assess diastolic dysfunction and left ventricular remodelling using echocardiography to compare how cardiovascular stress differs
- Explore variations in ophthalmic artery doppler indices potentially revealing cerebrovascular changes linked to pre-eclampsia
- Examine PIGF and GlyFn to identify variation in biomarkers and uncover age-related differences in disease progression Investigate metabolic differences using POC NMR-based metabolomics