Simple, scalable innovations & research capacity building to improve maternal health in Sierra Leone.
In Sierra Leone, 1 in every 17 women will die during pregnancy or childbirth. It is one of the most dangerous places to give birth in the world.
This NIHR Global Health Research Group is a partnership between the University of Sierra Leone and King’s College London, with support from the National Midwifery Schools and Ministry of Health and Sanitation, to develop and implement life-saving maternal health interventions and build research capacity in Sierra Leone.
We are working with healthcare workers, educators, communities, and policy makers to understand and overcome the day-to-day barriers that women and healthcare providers face when accessing or delivering effective maternity care. We aim to generate new scientific knowledge and implement solutions and build research capacity and expertise where it is needed most.
OBJECTIVES
Our group, “Simple, scalable innovations & research capacity building to improve maternal health in Sierra Leone” has focused on improving maternal and neonatal health outcomes. We have shown that three-quarters of women die from bleeding, infection, or blood pressure problems, all of which can be identified by measuring blood pressure and heart rate, and are preventable with simple, low-cost interventions. However, Sierra Leone lacks adequate monitoring equipment and healthcare staff, meaning women may experience delays in receiving timely, lifesaving care.
- Our primary objective was to reduce deaths of mothers and their babies in Sierra Leone. To do this, we co-created a programme of work in collaboration with our research colleagues and implementing partners to develop, evaluate and implement novel life-saving interventions. Through equitable partnerships, with ongoing stakeholder engagement, we have strived to drive the delivery of sustainable, evidence-based, and effective maternity and newborn care.
- We aimed to build sustainable research capacity, which was currently underdeveloped. In the UK, research underpins health policy and improvements in care, but in Sierra Leone, there are no formal training opportunities to develop maternal health research leaders. We have built junior research capacity through local PhD students in Translational Research, Implementation Science, and Health Policy and Economics. Research training and leadership were incorporated into the National School of Midwifery’s curricula and the novel post-graduate O&G training programme in Sierra Leone. We have embedded a cadre of medical / midwifery academics within our programme of research, mentoring diverse research staff through higher degree supervision, research modules and direct mentorship.
- We have worked with the Ministry of Health and Sanitation’s Quality Management Directorate to build the country’s first Patient and Public Involvement Initiative, giving women and community members in Sierra Leone a stronger voice.
Within our programme of research, our main objectives were to:
- Conduct a Type 2 Implementation-Effectiveness stepped-wedge randomised controlled trial to evaluate the impact of scaling up the CRADLE Vital Signs Alert device in rural Sierra Leone on maternal and neonatal outcomes, as well as determining the factors that contribute to its effective implementation. The evidence accrued provided a blueprint for worldwide adoption and impact.
- Evaluate the 2 Young Lives mentoring scheme, the aim of which was for mentees and their babies to survive birth and the postnatal period, and to empower these young women economically and socially to thrive. The aim of this feasibility cluster randomised controlled trial was to evaluate event rates, assess the feasibility of data collection and understand potential treatment effects, while also determining factors to optimise the intervention.
- Determine whether shock index (heart rate / systolic blood pressure) is an optimal predictor of poor pregnancy outcomes, compared to conventional vital signs in women who are bleeding or have severe infection in a rural setting.
- Validate the accuracy and feasibility of a point-of-care creatinine device to detect acute kidney injury in women who are bleeding, have severe infection or problems of high blood pressure during pregnancy. We also determined if this point-of-care test and supportive intervention could reduce the incidence of kidney injury in pregnant women.
- Implement a cost-benefit analysis and subsequent adoption and policy pathway. The health economics component provided support for expanding the research capacity related to health economics in Sierra Leone, particularly focusing on methods for maternity economic evaluations in lower-middle-income countries. We co-produced progress updates with global policymakers and published our findings widely in the Global Health Community to ensure that learning was shared.