Professor Andy Shennan from Kings College London was invited to give a keynote lecture at the joint Zimbabwe Society of Obstetricians and Gynaecologists (ZSOG) and the East, Central and Southern Africa College of Obstetrics and Gynaecology (ECSACOG) Scientific Conference at Victoria Falls in Zimbabwe, in October 2022. The theme of the conference was “Rising above challenges to ensure quality evidence based reproductive healthcare: a collaborative approach”.
ECSACOG was started in 2017 and represents 10 countries with a passion to improve care in Africa. This keynote lecture highlighted the importance of research capacity building in Africa and the need to evaluate cost effective interventions to improve perinatal care here. Prof Shennan described the CRADLE programme which many of the conference participants have contributed to and is dedicated to this goal including representation from Uganda, Zimbabwe and Zambia. In addition, he highlighted the recently formed APECi website which provides dedicated training and educational resources both for clinicians and women. Please see: www.apecint.org . The conference provided an opportunity to plan next research steps and to continue to build research capacity in these and other countries around Africa and Asia.
Prof Shennan highlighted how addressing the management of pre-eclampsia provides a good strategy for making a quick difference and reducing mortality, using low-resource capabilities. The discrepancy in mortality between high and low-income settings for pre-eclampsia is stark, often over 100 fold, yet management to prevent this is not complicated nor expensive, and relatively easy to achieve in low resourced settings. In order to address this crisis, it is imperative to get people embedded in research pertinent to their own country’s issues. He went on to stress how optimal timing of delivery is a cost-effective approach – and that if you deliver someone when they are well, it is far better than delivering a sick mother and baby, with no ill effects. This simple approach can make a big difference and the social observation is that people who need things most, often don’t get them.
The Cradle device is a vital signs device for low-income settings and detects who needs urgent care; who needs to be transported and treated and empowers people who give the care through a simple traffic light system that detects high blood pressure and shock caused by haemorrhage and sepsis; these 3 conditions represent more than three quarters of the deaths in maternity in Africa. As the device detects shock, research in the Bidibidi refugee camp in Uganda, has demonstrated the device has also has even been helpful in identifying malaria. In southern India the device recognises severe anaemia. The CRADLE device has diverse potential to identify many conditions in a cost-effective way.
For Prof Shennan, not only was this a chance to be back in Africa, where his roots are (his grandfather opened a clinic in Bulawayo that is still very active and his aunt was Superintendent at the Parirenyatwa hospital in Harare) but it was an opportunity to share the results of the latest trial conducted in Zimbabwe and India (Cradle 4) for the first time and to develop networks with academics and clinicians working in this important field.
