Dear friends, partners, and supporters:
As I reflect on this past year and think about the progress that we, as a multi-country collaboration have made, I can’t help but smile. I think about the young mothers learning to care for their fragile, tiny newborns. I imagine our committed midwives wrapping those babies to their mothers’ chests for vital skin-to-skin warming. I think about the tremendous progress we’ve made in strengthening data and national health information systems, as well as mentoring and training for clinicians in all three countries to improve their quality of care. I am grateful for the strong partnerships we have built with Drs. Phelgona Otieno, Peter Waiswa, Sabine Musange, and their teams in Kenya, Uganda, and Rwanda respectively. Together, we will make measurable impact, we will save mothers and newborns.
The journey has not and will not be easy. Every day, I am reminded that for so many newborns in East Africa, prematurity is a death sentence. Last year, across the world, nearly 750,000 preterm babies died within the first 28 days of life – the places where we work see a disproportionate share of these deaths. Our partnership is committed to dramatically reducing these numbers.
To see an overview of our efforts in East Africa, please view the first video below. To learn more about the importance of data collection to our work, please view the second. Then scroll through this report to learn more about our data-strengthening work, interventions package, group antenatal care trial, capacity-building fellowship, and discovery research in preterm birth.
In closing and with much gratitude, I want to acknowledge our generous funder, the Bill & Melinda Gates Foundation; our tireless staff and researchers at UCSF, KEMRI, Makerere University, and the National University of Rwanda School of Public Health; as well as our partners at the ministries of health in Kenya, Rwanda, and Uganda. As the saying goes, “it takes a village to raise a child.” Well, it takes a village to save these newborns too, and I couldn’t ask for a more committed, passionate village to be working with.
Dilys Walker MD, Principal Investigator, PTBi-EA
The East Africa Preterm Birth Initiative Story
A Day in the Life of Data: Making Every Action Count
Together with the Kenya Medical Research Institute (KEMRI), we are conducting implementation research, lead by Dr. Phelgona Otieno, at 17 health facilities in Migori County. Our work in early 2016 focused on assessing those facilities for project readiness and strengthening use of existing facility-based data collection, tools, and practices. Towards the later part of the year, we began rolling out an interventions package that includes a customized version of the WHO’s Safe Childbirth Checklist, simulation and team training for providers through PRONTO International (preparing clinicians to better identify and manage preterm births), and training for health facility staff in quality improvement cycles. We feel confident that this package of interventions will improve the quality of care for mothers and newborns and ultimately save lives.
Drawing on previous research in the US that shows group care can reduce preterm birth rates, our work in Rwanda focuses on group antenatal and postnatal care (referred to as prenatal and postpartum in the US). Partnering with the University of Rwanda’s Dr. Sabine Musange and the Rwanda Biomedical Center, we are performing the largest cluster randomized control trial of group antenatal and postnatal care in the world. 10,000 women across 36 government health centers in five districts will participate.
Our work in 2016 focused on the assessment of facility readiness, qualitative work on attitudes toward antenatal care, and development of a model for group care that would meet the specific needs of Rwandan women. A technical working group of stakeholders met several times during the year to develop and refine the model. Towards the end of 2016, we began training Rwandan midwives as master trainers, who will in turn train the midwives, nurses, and community health workers charged with delivering group care.
The trial will launch in April 2017. Our results will provide the global maternal-child health community with long-awaited information about the feasibility and effectiveness of group antenatal care in low- and middle-income countries. With positive findings from this trial, we hope to provide a model of group care that can be adapted to other low- and middle-income countries, ultimately curbing preterm birth. In 2019, with results from all 10,000 women and newborns, we will report on whether this innovative model of antenatal care is able to reduce the preterm birth rate in Rwanda.
Principal investigator, Dr. Peter Waiswa of Makerere University, leads our implementation research collaboration in Uganda, where we are working with six health facilities in the Busoga region. As with our work in Kenya, our teams spent the first half of 2016 assessing those facilities for project readiness and strengthening the use of existing facility-based data collection tools and practices. Later in 2016, we began rolling out the same interventions package we introduced in Kenya. The package includes a Uganda-specific, customized version of the WHO’s Safe Childbirth Checklist, simulation and team training for providers through PRONTO International (preparing clinicians to better identify and manage preterm births), and training for health facility staff in quality improvement cycles. We feel confident that this package of interventions will improve the quality of care for mothers and newborns, ultimately saving lives in both Kenya and Uganda.
Phelgona Otieno, MBChB, MPH PTBi-Kenya
"One of the greatest challenges of doing this work is having facility staff involvement in the interventions we are providing. We are using several approaches to create awareness, build confidence in correct diagnoses, and increase active involvement of facility staff. These are key for the care of preterm babies"
Dr. Phelgona Otieno, PTBi-Kenya principal investigator, is a pediatrician and epidemiologist with long-standing experience in conducting HIV research, running child health programs, and mentoring health professionals. She currently serves as a principal research officer at Kenya Medical Research Institute (KEMRI) within the Sexual, Reproductive, Adolescent and Child Health Division.
Sabine Musange MD, MSc, PTBi-Rwanda
"To turn the curve on prematurity is to continue to build local human capacity in the area of maternal, neonatal, and child health, and scale up interventions that have been proven to work in this setting. We are motivated about our work because every mother and child deserves the chance to thrive without the burden and stress of preventable complications, death, or prematurity."
Dr. Sabine Musange, PTBi-Rwanda principal investigator, has significant experience in healthcare, financing, and economics along with leading donor projects. She is currently completing a PhD in implementation science at the University of Washington, Seattle.
Peter Waiswa MBChB, MPH, PhD, PTBi-Uganda
“Our vision is a country and an Africa that recognizes the problem of prematurity but also implements low-cost health systems innovations with quality, equity, and scalability”
Dr. Peter Waiswa, PTBi-Uganda principal investigator, is a medical doctor and health-systems researcher with particular focus on newborn health and development and maternal-newborn-child health services. He is a frequent advisor to international organizations on perinatal-newborn health. With a background in district health service provision in rural Uganda he holds a joint PhD degree from Karolinska Institutet and Makerere University, and is on the faculty at Makerere University School of Public Health, Uganda, as well as Karolinska Institutet, Sweden.
Dilys Walker MD, PTBi-East Africa
"We will not rest until pregnancy complications are no longer a death sentence for mothers and newborns. We are moving forward with a clear vision and approach that are both sustainable and scalable."
Dr. Dilys Walker, PTBi-EA principal investigator, is an obstetrician gynecologist and a professor in the departments of Obstetrics, Gynecology, and Reproductive Sciences, and Global Health Sciences at the University of California, San Francisco. Dr. Walker and her team developed a novel approach to emergency training – PRONTO – using highly-realistic simulation and team training to improve obstetric and neonatal outcomes. She is the co-founder of the NGO PRONTO International and is currently running PRONTO implementation trials in Mexico, Guatemala, Kenya, and India. As principal investigator for PTBi-EA, Dr. Walker provides oversight and leadership for the research in Kenya, Uganda, and Rwanda.