NIHR Global Health Research Group: Implementation of simple solutions to reduce maternal and neonatal mortality and build research capacity in Sierra Leone

We propose to create an NIHR Global Health Research Group, focussed on reducing maternal and neonatal mortality in Sierra Leone. Background to the planned research: In Sierra Leone (SL) 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, with 40% of all maternal deaths occurring amongst teenagers related to poor access to care. It is widely recognised that many women die in pregnancy because the problem is recognised too late, related to late care-seeking behaviour, and treatment delay once admitted. In all of these instances, triage following simply monitoring could be lifesaving. Early recognition is required to allow timely management and treatment to be instigated before serious, irreversible complications or death. Unfortunately in SL, access and availability of monitoring equipment is challenging; Our aims are to: • To evaluate the impact of the CRADLE VSA, a novel monitor that detects blood pressure and pulse and calculates shock, with a traffic light alert, in a rural setting and to validate the use of other point of care (POC) technologies in the management of haemorrhage and sepsis; specifically the Shock Index (SI) readily available on the CRADLE VSA, and a POC creatinine device to detect acute kidney injury. • Evaluate the impact of the 2 young lives intervention of mentorship scheme to teenagers, and the contribution hypertensive disorders make on teenage maternal and neonatal mortality. • Determine the health economic benefit of implementation of the CRADLE VSA intervention through evaluating the costs of context specific process and impact on clinical outcome measures and define the necessary policy framework for the ultimate roll out of the optimal interventions determined in our current research. • Build junior research capacity through 3 local PhD students (in implementation science, health policy and economics), and incorporate research training into the National School of Midwifery’s curricula and mentoring a cadre of medical/midwifery academics through KCL Master’s modules in Public Health and Research Methodology. This will include working with the MoHS’ Quality Management Directorate to build the country's first PPI programme. UK Academics will mentor senior clinicians and build fellowship opportunities for health professionals, including through the NIHR Leadership Programme. Methods 1) An evaluation of the CRADLE VSA in 8 districts (50% of the country) i.e. a rural setting, using pragmatic, stepped-wedge, type 2 hybrid implementation-effectiveness trial, implementing the adapted CRADLE intervention into the remaining 8 districts in Sierra Leone. • A feasibility cluster randomised trial to evaluate the mentorship intervention on teenage mortality and other morbidities. • Validation of the shock index and Cr POC technologies in high risk pregnancies to predict adverse outcomes. • A cost benefit analysis and subsequent adoption and policy pathway of all these interventions The trials will recruit, and complete data collection and report within the 36 month programme. The observational data in all validation studies will complete within these trials. The outputs will be published in high impact journals, and shared with relevant policy and other stakeholders nationally. We will disseminate at international conferences.