K43TW012579

Multidisciplinary Sickle Cell Disease Obstetrics Care Program in Ghana: Non-Academic vs. Academic Hospital (Pilot Study) - With increasing life expectancy in Africa, pregnancy has become an emerging life-threatening complication in SCD women. In low and middle-income countries, the odds ratio of maternal death associated with SCD is 22.81, 95% CI 14.67–35.46.

From 2012-2014, the Obstetrics Department, Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, established an obstetrician-led SCD Obstetrics (OB) clinic. The institutional maternal mortality for SCD over these three years (2012-2014) was approximately 12%.

In January 2015, a multidisciplinary SCD OB team was established. The team conducted a combined retrospective/prospective case series of all maternal deaths in women with SCD at KBTH over seven years (2010-2016). This retrospective data collection highlighted failures and challenges to delivering improved care. Acute chest syndrome, preceded by acute pain episodes, was the leading cause of death in nearly 87% of women.

In May 2015, the team implemented a joint Obstetrics/Hematology clinic, instituted close maternal and fetal monitoring, and implemented clinical guidelines/protocols. In addition, the SCD OB team established a weekly communication system to adjudicate the management of challenging cases. These interventions resulted in an 89.1% risk reduction in maternal mortality (from 10,791 to 1,176 deaths per 100,000 live births; p=0.007) over 13 months.

Since initiating our multidisciplinary SCD OB program, we have consistently decreased maternal mortality in this cohort by approximately 90% compared to before the team was established.

This physician-mentored application aims to conduct an effectiveness-implementation feasibility study to extend our results of decreasing maternal mortality from an academic hospital to a non-academic hospital setting in Accra, Ghana with a current maternal mortality rate of 5,940 deaths/100,000 live births in SCD women.

Over five years, the applicant will acquire the skills to use the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to inform the stages of the study.

The applicant will test the hypothesis that "in a before and after study design, the applicant will test the hypothesis that multidisciplinary care and task-shifting in a non-academic hospital for pregnant women with SCD will have an 80% relative risk reduction in death compared to the mortality rate in the same hospital before the multidisciplinary medical care."

The specific aims for this mentored award are:
1) Identify contextual determinants (barriers/facilitators) that influence the adaptability of the evidence-based practice for establishing a multidisciplinary SCD OB team as an intervention in the non-academic hospital, including the implementation process (years 1-2).
2) Build capacity for a multidisciplinary SCD OB program in a non-academic hospital (years 3-5).
3) Conduct a hybrid type 1 feasibility study comparing the effectiveness of a task-shifted multidisciplinary SCD OB program in a non-academic site (years 3-5).

College Of Health Sciences, University Of Ghana

THE JOHN E. FOGARTY INTERNATIONAL CENTER (FIC) SUPPORTS RESEARCH AND RESEARCH TRAINING TO REDUCE DISPARITIES IN GLOBAL HEALTH AND TO FOSTER PARTNERSHIPS BETWEEN U.S. SCIENTISTS AND THEIR COUNTERPARTS ABROAD. FIC SUPPORTS BASIC BIOLOGICAL, BEHAVIORAL, AND SOCIAL SCIENCE RESEARCH, AS WELL AS RELATED RESEARCH TRAINING AND CAREER DEVELOPMENT. THE RESEARCH PORTFOLIO IS DIVIDED INTO SEVERAL PROGRAMS THAT SUPPORT A WIDE VARIETY OF FUNDING MECHANISMS TO MEET PROGRAMMATIC OBJECTIVES.

93.989 - International Research and Research Training

Fogarty International Center (FIC) [HHS - NIH]

Ghana

Foreign

Emerging Global Leader Award (K43 Independent Clinical Trial Required) (PAR-21-251)

Amendment Since initial award the total obligations have increased 200% from $85,309 to $255,940.