Dr Alice Pearson & Dr Charlotte Greene
We both began medical school as post-graduates; Alice having studied Biochemistry at Bristol and Charlotte History at Oxford. We then graduated from medical school at King’s College London in 2020 where we lucky enough to meet Professor Andrew Shennan and learn about the CRADLE device. Having completed foundation training in Edinburgh, we spent three months this year in Sierra Leone working on this project. It was a hugely educational, rewarding and fun experience. We are very grateful for the grants we received from the organisations listed on our poster. This summer Alice will be starting speciality training in Paediatrics and Charlotte will be starting Anaesthetics. We both hope to continue working in global health in the future.
Sierra Leone (SL) has one of the highest rates of maternal mortality globally. The CRADLE VSA is a vital signs monitoring device with an associated training package designed to enable early recognition and management of unwell pregnant women. Following a successful trial in SL which showed a reduction in maternal mortality of 60%, the CRADLE device was rolled out across 8 (of 16) health districts in May 2020 – March 2021. Anecdotally there have been some reports amongst users of broken devices, and this needs further evaluation to ensure sustainability of the intervention.
1) To establish the proportion of CRADLE VSA devices reported as ‘broken’ and to systematically identify causes
2) To explore existing ‘maintenance and repair’ pathways to inform development of a robust maintenance strategy that can be applied at national level
Data was collected from five districts in Sierra Leone between January-March 2023. ‘Broken’ devices were collected and categorized by problem. A selection of district health team, medical technicians and clinical staff were interviewed to explore barriers to maintenance and sustainability.
During the national scale up, 1257 devices were distributed amongst the 5 districts. Of these n = 261 (20.8%) were reported ‘broken’. Allowing for devices that were working or damaged in storage, the commonest problems were cuff, n= 176 (75%), bulb, n= 100 (43%) and machine, n=43 (18%). 100% of interviewees were able to identify these specific problems. Barriers to repair included logistical challenges transporting broken devices, communication breakdown and high staff turnover.
The commonest problems were related to the cuff and bulb. These are cheap and easily replaced at the healthcare facility by local staff. We provided districts supplies of spare cuffs and bulbs and produced a training video for users and medical store staff to identify and repair common problems. These simple changes could improve the sustainability of the device and facilitate long-term use.