Katy Kuhrt is a Clinical Research Fellow in Obstetrics and Gynaecology. She is currently undertaking her PhD at King’s College London which focuses on evaluation of novel point of care tests in pregnant women to improve triage and referral in Sierra Leone, which has one of the worse maternal mortality rates in the world. Her work will include an assessment of a point of care creatinine test in pregnant women with acute kidney injury, a test to predict pre-eclampsia and an evaluation of shock index as a triage tool and predictor of poor outcome in pregnant women who are bleeding. The Policy Lab is part of the work designed to better understand the context for successful translation of new research evidence generated by these studies, and others, into improved pregnancy outcomes in Sierra Leone.
Pre-eclampsia is the second leading cause of maternal death globally, including Sierra Leone, where women are 2000 times more likely to die compared to the UK. Key reasons are delayed detection and lack of appropriate action (anti-hypertensives, anticonvulsants, delivery). In Sierra Leone, we demonstrated that early identification of abnormal vital signs is associated with a reduction in maternal mortality, and enables targeted interventions (early delivery), which saves babies lives (NNT = 30), and reduces severe maternal hypertension. Policy Labs are an engagement approach used to facilitate research evidence uptake into policy and practice. Integration of this novel evidence into maternity care is critical to minimise adverse outcomes.
Based on the ‘trust-translation-timing’ model developed by King’s Policy Institute we co-hosted a Policy Lab with the Ministry of Health and Sanitation in Sierra Leone attended by a diverse group of stakeholders, who received a briefing pack synthesizing key evidence prior to the event. Participants discussed barriers and facilitators in small, mixed groups and devised collaborative strategies for translation of the new research into pre-eclampsia management.
39 attendees (women, community representatives, religious leaders, health workers, policy makers and politicians) identified multiple challenges, i.e.: lack of awareness of pre-eclampsia and its associated risks, cost of transport, lack of trust in healthcare, and women being asked to pay for care. Key recommendations included intentional community engagement through public health education campaigns, and specialized Pre-eclampsia Care centres. 15 participants formed a technical working group and are currently involved in development and delivery of a national pre-eclampsia awareness programme.
Early detection and appropriate action is a critical issue for pre-eclampsia management in Sierra Leone. Policy Labs are an effective tool to facilitate the co-development of evidence-based collaborative policies, including community education and empowerment, to expedite reduction in mother and infant morbidity and mortality.