Pregnancy complications that raise blood pressure can silently damage a woman’s heart and kidneys for years after childbirth, yet most women in Sub-Saharan Africa never receive follow-up care. This problem matters because hypertensive disorders of pregnancy affect one in ten pregnancies globally, and cardiovascular disease is the leading cause of death in women worldwide. Women of African ancestry face particularly high risks of developing chronic hypertension and premature heart disease after such pregnancies, but data on how common these conditions become after childbirth in low- and middle-income countries are scarce. The postnatal period offers a unique window to detect and manage hypertension, yet poor healthcare access, limited knowledge, and low trust in health systems prevent effective care. If successful, this project will produce a community-based intervention—led by trained local champions—that is both trusted and cost-effective. The researchers will track 2,409 women across Sierra Leone, Zambia, and South Africa for 12 months, using portable diagnostic tools to detect early organ damage. A randomised trial will test whether the intervention lowers blood pressure and prevents heart and kidney damage. The goal is a scalable model that could be rolled out across other low-resource settings, improving women’s health through future pregnancies and into old age.
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Research Question: Can a co-developed, targeted, community-based postnatal intervention for women with hypertensive disorders of pregnancy in Sub-Saharan Africa facilitate earlier detection, improve hypertension management, and prevent hypertension-mediated organ damage? Background: Pregnancy is a stress-test of cardiometabolic health. Hypertensive disorders of pregnancy (HDP) are associated with subsequent risk of chronic hypertension (CHT) and premature cardiovascular disease (CVD), especially in women of African ancestry. HDP affect 10% of pregnancies and CVD is leading cause of death in women worldwide. However, data on postnatal prevalence of CHT after HDP and associated hypertensive-mediated-organ-damage in LMICs are limited. Early postnatal care provides a unique opportunity to detect and manage CHT through evidence-based interventions. However effective care is challenging due to limited knowledge, poor healthcare access, and low levels of trust in healthcare systems, particularly among vulnerable groups. Our approach builds on our successful foundational work supporting management of HDP in Sub-Saharan Africa, including community engagement initiatives, co-development of materials for communities and healthcare professionals and point-of-care diagnostics Aim: To co-develop and evaluate a targeted, community-based postnatal intervention for women with HDP, to facilitate earlier detection, improved hypertension management and prevention of hypertension-mediated-organ-damage in Sierra Leone, Zambia and South Africa. Objectives: To establish community partnerships and mapping to inform design, delivery, and dissemination of community-led interventions (Workstream-1). We will facilitate theory-of-change workshops and community education to develop a contextually tailored intervention. Meaningful community engagement and involvement will be essential throughout the program. To undertake a multi-national longitudinal cohort study of women (N=2409) with previous and current HDP to assess CHT prevalence, onset and burden of hypertension-mediated-organ-damage with point-of-care testing and inform future data collection (Workstream-2). Primary outcome: systolic blood pressure after 12 months. Secondary outcomes: diastolic blood pressure, left-ventricular hypertrophy, chronic kidney disease, cardio/cerebrovascular events. Informed by Workstreams-1&2, to undertake a type-2 hybrid implementation-effectiveness randomised cluster trial of a co-developed community champion led intervention to improve blood pressure and address knowledge, access and trust for women with HDP (Workstream-3). Primary outcome: systolic blood pressure after 12 months. Mixed-effect models will be used to examine clinical and implementation outcomes. Health economic analysis will evaluate the intervention's cost-effectiveness, guided by a comprehensive process evaluation to inform rapid scale-up To strengthen local research capacity at individual, organisational and institutional levels (Workstream-4). We will develop targeted training programmes to enhance postgraduate research skills, post-doctoral training, research delivery and fostering interdisciplinary collaboration. By promoting collaboration and knowledge exchange from diverse backgrounds, sustainable research hubs will be established within the target communities. Timelines for delivery: Workstream-1 May 2025-Mar 2026; Workstream-2 March 2025-Dec 2028; Workstream-3 July 2025-Mar 2029. Community engagement and involvement and research capacity strengthening activities (Workstream-4) will take place throughout. Anticipated Impact and Dissemination: We anticipate development of an accessible, trusted, and cost-effective community-based intervention for postpartum hypertension management which is rapidly scalable and will improve women s health throughout their life-course including future pregnancies, and health of the wider family. We will disseminate co-developed findings
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