PregnAncy screening Programme:
Assessment of feasibility, Acceptability, and complex intervention development in Sierra Leone
THE PROBLEM TO ADDRESS
Pre-eclampsia is the second leading cause of maternal death worldwide, with over 90% of these deaths occurring in low- and middle-income countries (LMICs). In Sierra Leone, a woman is over 2000 times more likely to die from pre-eclampsia than in the UK.
A significant proportion of maternal and neonatal deaths due to pre-eclampsia can be prevented with simple, scalable, sustainable, and contextually applicable solutions. Specifically, timely access to quality antenatal care, community knowledge/awareness, and health-seeking behaviour. Quality antenatal care includes comprehensive risk assessment, screening and diagnosis to inform appropriate management pathways and skilled healthcare workers. Therefore, a contextually applicable risk assessment tool must be developed.
Low-dose aspirin initiated before 16 weeks’ gestation as a prophylaxis is a simple and scalable intervention that can significantly reduce the incidence of pre-eclampsia in high-risk pregnancies and prevent unnecessary maternal and neonatal mortalities. However, in Sierra Leone, there is limited access to LDA (<1%) and an overwhelming proportion of women (88%) present late to their first antenatal care visit (>16 weeks). Consequently, a significant proportion of high-risk women are unable to receive aspirin during its period of efficacy.
Delayed initiation of ANC is exacerbated by a resource-constrained healthcare system and social determinants of health (SDH). For example, there are limited skilled healthcare workers and resources to conduct sufficient risk-factor-based screening. This emphasises the underreported prevalence of cardiovascular disease and pre-eclampsia risk factors within this population. Additionally, low socioeconomic status and geographic distance limit a woman’s ability to access timely care. Consequently, the identification, diagnosis, and proper management of women with pre-eclampsia is limited.
Early (<16 weeks) access to quality care can significantly reduce the number of maternal and neonatal deaths attributed to pre-eclampsia and long-term health effects (i.e. chronic hypertension and stroke).
THE PROJECT’S OBJECTIVES
- To develop educational materials and assess the impact of community engagement and empowerment on the uptake of early antenatal care before 16 weeks in Sierra Leone
- To evaluate the feasibility, acceptability, and performance of screening for pre-eclampsia by combinations of systolic and diastolic blood pressure, maternal factors, and point-of-care glycosylated fibronectin and point-of-care placental growth factor before 28 weeks
- Determine the feasibility of risk-factor-based screening using point-of-care biomarkers (GlyFn and PIGF)
- Evaluate the feasibility and acceptability of using an AI-enhanced gestational age assessment using point-of-care ultrasound
