Every year, 75% of the world’s 2 million stillbirths occur in sub-Saharan Africa and South Asia, yet the evidence on how to prevent them comes almost entirely from wealthy countries. This project works directly with hospitals in Kenya, Tanzania, Uganda, Malawi, Zambia and Zimbabwe to close that gap. It focuses on three practical work streams: detecting fetal distress through reduced fetal movements—a low-cost method that has barely been tested in low-resource settings—improving care during labour, and ensuring respectful treatment for bereaved parents. The team has already trained 150 midwives in research and audit through the LAMRN network, and will embed the work within a WHO Collaborating Centre. If successful, the findings could give clinicians in low- and middle-income countries simple, evidence-based tools to identify at-risk pregnancies and reduce the current stillbirth rate, which is falling at only 1.9% per year—less than half the rate needed to meet the UN’s 2030 target. The research also addresses the long-term mental health consequences for the estimated 4.2 million women who experience depression after a stillbirth.
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a)The UoM prioritises cross and inter-disciplinary research addressing key global challenges with a strategy focused on making pioneering discoveries and improving the lives of people globally. This project speaks to our Addressing Global Inequalities research beacon which combines the best academic minds to meet these challenges head on. b)UoM hosts the Maternal and Fetal Health Research Centre which is focused on prevention of stillbirth and improving care for bereaved parents in the UK. The centre, embedded in St Mary’s Hospital, includes 80 obstetricians, midwives and researchers. This project will allow the group to expand to address stillbirth as a global health issue. It will be embedded within the UoM Centre for Global Women’s Health, a WHO collaborating centre with existing expertise and established networks. c)Existing and future investments revolve around the key aims of training outstanding researchers and giving parity of esteem to discovery, application, knowledge transfer and impact. Our commitment to addressing key global challenges, is recognised by the WHO, with Collaborating Centre status awarded to 3 UoM research groups. d)Stillbirth was described in the Lancet (1) as one of the most neglected tragedies in global health; 75% occur in Africa and South Asia. Human costs are long-lasting, extending beyond the mother to her family, and society; an estimated 4.2 million women have associated depression (2). Despite this, stillbirth was absent from the MDGs and overlooked in international policy. UNICEFs Every Newborn Action Plan (ENAP) challenges countries to reduce stillbirth rates to <12 per 1,000 births by 2030. The current rate of reduction is only 1.9%; more than a twofold increase to 4.2% is needed to achieve the ENAP target (3). A major barrier to achieving this goal is that evidence is largely synthesised in HICs and rarely applied to LMIC settings. There are differences in the causes of stillbirth in LMICs, e.g. 50% of stillbirths occur during labour in comparison to <10% in HICs. Critically, stillbirth reduction can lead to less adverse neonatal and maternal health outcomes. The Lancet Series(1) highlighted the need to expand stillbirth research in LMICs. This requires implementation of effective interventions to prevent and respond to stillbirths. We will address prevention and detection in pregnancies at high risk of stillbirth, intrapartum management and respectful care in 3 work streams(WS). These will run in parallel to a capacity development programme and monitoring and evaluation(M&E) strategy. These work streams will be delivered via LAMRN (founded by Lavender) which has established relationships with care providers in Kenya, Tanzania, Uganda, Malawi, Zambia and Zimbabwe. LAMRN has trained 150 midwives in research/audit. Prior relationships with key in-country stakeholders and the International Stillbirth Alliance (ISA) will foster programme support and enable practice and policy implementation. WS 1 Prevention and detection (Heazell, Smyth) Background: As 50% of antepartum stillbirths are preceded by reduced fetal movements (RFM), education of women about fetal movements and identification of fetal compromise may reduce antepartum stillbirths. Monitoring of fetal wellbeing, in this way is attractive as it requires little initial resource. Yet, few studies in LMICs have evaluated RFM as a tool to prevent stillbirths. Aim: To establish current practice regarding fetal movements and fetal wellbeing and the accuracy and availability of methods to assess fetal wellbeing after perception of RFM in LMICs. To develop an intervention to identify fetal compromise based on RFM. Method: Explore, qualitatively, womens’ and professionals’ views of RFM as a screening tool for fetal compromise and identify barriers to accessing care. Perform a cohort study to evaluate which facets of clinical history, examination and investigation most accurately predict adverse outcome after RFM and ev
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