THE PROBLEM TO ADDRESS
Sierra Leone has one of the highest maternal mortality rates in the world. In 2015, a community-based household survey conducted in Eastern Freetown in partnership with Lifeline Nehemiah Projects (LNP) showed 1 in 10 maternal deaths are among pregnant adolescents, and a following qualitative study revealed contributing factors such as poverty, stigma and abandonment, lack of family-based support and delayed care-seeking. A mentoring scheme for the most vulnerable pregnant girls was one of the potential interventions identified as an upstream solution to maternal/perinatal mortality for adolescent girls and their babies.
Thus in 2017, they developed and piloted a locally designed community and relationship based mentoring intervention ‘2YoungLives’ (2YL) from pregnancy through to one year after birth for adolescent girls. Mentors who are kind, compassionate, respectful community members and leaders are recruited and trained. They support pregnant girls to: prepare for motherhood, attend antenatal care and deliver at facilities; meet other pregnant mums, re-establish family connections’ have practical advice about childbirth, parenting, health- seeking behaviour (for mother and baby), contraception; run small business; and re-engage with school or start vocational learning (with an educational bursary).
After a small-scale pilot across 4 districts over 4 years, preliminary results (PDF) are promising. 2YLs has mentored over 200 girls with no maternal deaths and around 8% perinatal loss. Girls report close loving relationships with their mentors, and a sense of agency and wellbeing. Some of the mechanisms by which intervention may work include engagement and advocacy, relationships building, education, social and economic empowerment, and respectful community engagement. However, a more robust evaluation is needed to understand how 2YL may work and its clinical, social and economic impact on other communities.
As part of the NIHR CRIBS group, we are now carrying out a hybrid type 2, pilot cluster randomised controlled trial in 12 areas (both rural + urban) to assess the feasibility of 2YLs in new communities and inform procedures for a larger scale up programme.
This study will allow us to assess acceptability and feasibility of recruitment, retention, sample size calculations, data collection, analysis, potential treatment effects and costs. A nested mixed methods process evaluation will explore contextual factors, implementation (i.e. acceptability, fidelity, adoption, sustainability), mechanisms, & experiences of care, health & wellbeing. We will also conduct a photovoice community participatory study to understand the social dimension of girls’ everyday lives needed to foster social change.
The Lifeline Nehemiah Project 2YoungLives implementing team
Led by Prince Tommy Williams, Lifeline Nehemiah Projects (LNP) is a grassroots NGO originally founded to support and reintegrate child soldiers and other war affected children after the civil war.
Deeply rooted in the community, LNP specialise in youth mentoring and development, with expertise in community engagement.
After a period of visiting communities to build trust and understanding by the LNP team, mentors have been recruited in consultation with communities, and attended our bespoke 4-day training using discussion, song and role play.
One year of CRIBS-2YL
The team has worked tireless during the first year of CRIBS: development of project materials, recruitment of staff (programme manager, research assistants, data collectors), design of online Medscinet database, award of a PhD studentship, ethics and governance approvals, piloting of the data collection processes, trial registration, in-country visits and support in research capacity building, community engagement and involvement activities, recruitment and training of mentors.
Recruitment of trial participants commenced in July 2022. We are starting soon monitoring visits and part of the qualitative work.
Our work was featured in the UNFPA State of the World’s Population Report 2022 (pages 50-51), and by the BBC World Service’s ‘People fixing the world’ series.