A collaboration between the University of Zambia and Kings College London
The University of Zambia and Kings College London jointly hosted a ground-breaking policy lab to gather relevant professionals together to stimulate discussion around potential strategies to adopt the findings of the CRADLE 4 study for planned early delivery for late preterm pre-eclampsia. The event was held at Ciela Resort, just outside Lusaka in Zambia.
The researchers gave new quantitative and qualitative evidence from the study in 5 sites in Zambia and 4 sites in India, showcasing outcomes from the trial which was conducted with 565 pregnant women with a clinical diagnosis of early pre-eclampsia. 282 women were allocated in the randomized control to planned delivery and 280 women were allocated to usual care from 34 weeks gestation. The key findings of the study were that planned delivery did not increase risk to the baby, and the mother had less severe hypertension. Around 1 in 30 babies died but the intervention reduced all baby deaths by 75%. Indeed, there were no antenatal still births in those routinely delivered and all still births occurred in the routine care group without any difference in neonatal deaths. In addition, there was no increase in the need for neonatal care, and although there were more survivors overall less medical intervention was needed in both mother and baby. The babies were better grown and the mothers returned home quicker. The intervention would therefore free up facilities and staff to care for others, so critical in low resourced centers.
The meeting brought together a diverse, passionate and engaged group of stakeholders committed to addressing maternal morbidity and mortality. The participants included midwives, nursing sisters, obstetricians, paediatricians, neonatologists, social scientists, NGO’s, district health directors, Obstetric department HODs and programme officers. Implementing planned early delivery for women with pre-eclampsia, without severe features, between 34 and 37 week’s gestation, needs collaboration and buy-in from medical professionals, communities, policy makers and pregnant women and their families, hence the need to look at how to engage, educate and empower them in order to move forward with this critical life-saving approach.
The lively discussions among the 50 participants centred around the current attitudes and beliefs around planned early delivery and the risks, benefits and challenges of planned early delivery for late preterm pre-eclampsia and strategies for implementing this approach. Some of the issues highlighted were that pre-eclampsia is not well understood in the community and there are myths and social issues about premature birth and that we need to engage the communities and include the right voices in the process of implementing this strategy. This requires education and sensitization of communities, including involving community leaders, church leaders, addressing cultural issues of family influence and input of husbands, providing training for Safe Motherhood Action Groups (SMAGs).
Suggestions on how to implement interventions that would assist in making early delivery more feasible and acceptable, flowed freely and included among others, adding pre-eclampsia into the school curriculum for teenagers, selecting a few districts and implementing a pilot of early delivery and showcasing the results – using the evidence data to change mindsets; sharing the powerful individual stories of women – packaging data into story telling; ensuring that health workers have what it takes to detect problems in pregnancy timeously; using the voice of champions who have had experience with pre-eclampsia on social media, radio and television to roll out messages dispelling myths and giving information about pre-eclampsia; empowering health care workers to counsel mothers and families; having campaigns during Safe Mother week and International pre-eclampsia day in local settings. It became apparent during discussions that communicating the new evidence of the research findings of the study – that there is no increase but actually a reduction in neo-natal admissions; that high-risk women need an intervention, is really critical in shifting attitudes and approaches to delivery and care for women and babies.
The policy lab concluded with the stakeholders committing to action plans and interventions to implement the findings of the CRADLE trial in various ways in the different communities, amongst clinicians and across hospitals, clinics and amongst programmes and policy makers.
The policy lab highlighted that maternal health and well-being, and taking active steps to avoid maternal mortality is an urgent public health issue, particularly for women living in low and lower-middle income countries. Also highlighted in the discussion was that there are multiple issues such as culture, myths, misconceptions impacting outcomes and decisions made about labour and delivery and the need to educate, inform, work together with church leaders, traditional healers and village chiefs as well as clinicians and policy makers. Overwhelmingly the policy lab discussion revealed a unified goal: to save lives – those of the mother and the baby and a real ambition to act now. The findings will be sent to all relevant stakeholders to help influence policy.
Professor Bellington Vwalika from University of Zambia said, “We appreciate the collaboration with Kings College London which grows from strength to strength as we build local capacity. This type of research will help improve outcomes for mother and baby. We value all the team who have delivered a successful trial at a difficult time”.
Professor Andrew Shennan from Kings College London commented, “For research to have impact, there must be uptake by all relevant stakeholders. Policy labs are a fantastic tool to facilitate change. We are so grateful for all participants spending their precious time with us”.