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Craik R, Volvert ML, Koech A, Jah H, Pickerill K, Abubakar A, D’Alessandro U, Barratt B, Blencowe H, Bone JN, Chandna J, Gladstone MJ, Khalil A, Li L, Magee LA, Makacha L, Mistry HD, Moore SE, Roca A, Salisbury TT, Temmerman M, Toudup D, Vidler M, von Dadelszen P. The PRECISE-DYAD protocol: linking maternal and infant health trajectories in sub-Saharan Africa. Wellcome Open Res 2024; 7:281. [PMID: 38779418 PMCID: PMC11109552 DOI: 10.12688/wellcomeopenres.18465.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/25/2024] Open
Abstract
Background PRECISE-DYAD is an observational cohort study of mother-child dyads running in urban and rural communities in The Gambia and Kenya. The cohort is being followed for two years and includes uncomplicated pregnancies and those that suffered pregnancy hypertension, fetal growth restriction, preterm birth, and/or stillbirth. Methods The PRECISE-DYAD study will follow up ~4200 women and their children recruited into the original PRECISE study. The study will add to the detailed pregnancy information and samples in PRECISE, collecting additional biological samples and clinical information on both the maternal and child health.Women will be asked about both their and their child's health, their diets as well as undertaking a basic cardiology assessment. Using a case-control approach, some mothers will be asked about their mental health, their experiences of care during labour in the healthcare facility. In a sub-group, data on financial expenditure during antenatal, intrapartum, and postnatal periods will also be collected. Child development will be assessed using a range of tools, including neurodevelopment assessments, and evaluating their home environment and quality of life. In the event developmental milestones are not met, additional assessments to assess vision and their risk of autism spectrum disorders will be conducted. Finally, a personal environmental exposure model for the full cohort will be created based on air and water quality data, combined with geographical, demographic, and behavioural variables. Conclusions The PRECISE-DYAD study will provide a greater epidemiological and mechanistic understanding of health and disease pathways in two sub-Saharan African countries, following healthy and complicated pregnancies. We are seeking additional funding to maintain this cohort and to gain an understanding of the effects of pregnancies outcome on longer-term health trajectories in mothers and their children.
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Affiliation(s)
- Rachel Craik
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Marie-Laure Volvert
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Angela Koech
- Centre of Excellence Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Hawanatu Jah
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Kelly Pickerill
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Benjamin Barratt
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | | | - Jeffrey N Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Jaya Chandna
- London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa J. Gladstone
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Asma Khalil
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Larry Li
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Laura A Magee
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Liberty Makacha
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Department of Surveying and Geomatics, Midlands State University, Gweru, Zimbabwe
| | - Hiten D Mistry
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Sophie E. Moore
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Anna Roca
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Tatiana T Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Marleen Temmerman
- Centre of Excellence Women and Child Health, Aga Khan University, Nairobi, Kenya
| | | | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Peter von Dadelszen
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - and The PRECISE-DYAD Network
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Centre of Excellence Women and Child Health, Aga Khan University, Nairobi, Kenya
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- MRC Centre for Environment and Health, Imperial College London, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Department of Surveying and Geomatics, Midlands State University, Gweru, Zimbabwe
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Medical School, University of Sheffield, Sheffield, UK
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2
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Koech A, Omuse G, Mugo AG, Mwaniki IG, Mutunga JM, Mukhanya MW, Wanje O, Mwashigadi GM, Katana GG, Craik R, von Dadelszen P, Le Doare K, Temmerman M. SARS-CoV-2 seroprevalence in pregnant women in Kilifi, Kenya from March 2020 to March 2022. Front Public Health 2023; 11:1292932. [PMID: 38169905 PMCID: PMC10760635 DOI: 10.3389/fpubh.2023.1292932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Background Seroprevalence studies are an alternative approach to estimating the extent of transmission of SARS-CoV-2 and the evolution of the pandemic in different geographical settings. We aimed to determine the SARS-CoV-2 seroprevalence from March 2020 to March 2022 in a rural and urban setting in Kilifi County, Kenya. Methods We obtained representative random samples of stored serum from a pregnancy cohort study for the period March 2020 to March 2022 and tested for antibodies against the spike protein using a qualitative SARS-CoV-2 ELISA kit (Wantai, total antibodies). All positive samples were retested for anti-SARS-CoV-2 anti-nucleocapsid antibodies (Euroimmun, ELISA kits, NCP, qualitative, IgG) and anti-spike protein antibodies (Euroimmun, ELISA kits, QuantiVac; quantitative, IgG). Results A total of 2,495 (of 4,703 available) samples were tested. There was an overall trend of increasing seropositivity from a low of 0% [95% CI 0-0.06] in March 2020 to a high of 89.4% [95% CI 83.36-93.82] in Feb 2022. Of the Wantai test-positive samples, 59.7% [95% CI 57.06-62.34] tested positive by the Euroimmun anti-SARS-CoV-2 NCP test and 37.4% [95% CI 34.83-40.04] tested positive by the Euroimmun anti-SARS-CoV-2 QuantiVac test. No differences were observed between the urban and rural hospital but villages adjacent to the major highway traversing the study area had a higher seroprevalence. Conclusion Anti-SARS-CoV-2 seroprevalence rose rapidly, with most of the population exposed to SARS-CoV-2 within 23 months of the first cases. The high cumulative seroprevalence suggests greater population exposure to SARS-CoV-2 than that reported from surveillance data.
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Affiliation(s)
- Angela Koech
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Geoffrey Omuse
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - Alex G. Mugo
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Isaac G. Mwaniki
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Joseph M. Mutunga
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Moses W. Mukhanya
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Onesmus Wanje
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Grace M. Mwashigadi
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Geoffrey G. Katana
- Kilifi County Department of Health and Sanitation Services, Kilifi, Kenya
| | - Rachel Craik
- Department of Women and Children’s Health, Kings College London, London, United Kingdom
| | - Peter von Dadelszen
- Department of Women and Children’s Health, Kings College London, London, United Kingdom
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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3
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Janha RE, Bah A, Jah H, Touray F, Idris Y, Keita S, Gaye Y, Jallow S, Faye-Joof T, Njie B, Craik R, Mohammed NI, von Dadelszen P, D'Alessandro U, Roca A. SARS-CoV-2 seroprevalence in pregnant women during the first three COVID-19 waves in The Gambia. Int J Infect Dis 2023; 135:109-117. [PMID: 37586660 DOI: 10.1016/j.ijid.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES SARS-CoV-2 transmission in sub-Saharan Africa has probably been underestimated. Population-based seroprevalence studies are needed to determine the extent of transmission in the continent. METHODS Blood samples from a cohort of Gambian pregnant women were tested for SARS-CoV-2 total receptor binding domain (RBD) immunoglobulin (Ig) M/IgG before (Pre-pandemic: October-December 2019) and during the pandemic (Pre-wave 1: February-June 2020; Post-wave 1: October-December 2020, Post-wave 2: May-June 2021; and Post-wave 3: October-December 2021). Samples reactive for SARS-CoV-2 total RBD IgM/IgG were tested in specific S1- and nucleocapsid (NCP) IgG assays. RESULTS SARS-CoV-2 total RBD IgM/IgG seroprevalence was 0.9% 95% confidence interval (0.2, 4.9) in Pre-pandemic; 4.1% (1.4, 11.4) in Pre-wave 1; 31.1% (25.2, 37.7) in Post-wave 1; 62.5% (55.8, 68.8) in Post-wave 2 and 90.0% (85.1, 93.5) in Post-wave 3. S-protein IgG and NCP-protein IgG seroprevalence also increased at each Post-wave period. Although S-protein IgG and NCP-protein IgG seroprevalence was similar at Post-wave 1, S-protein IgG seroprevalence was higher at Post-wave 2 and Post-wave 3, (prevalence difference 13.5 [0.1, 26.8] and prevalence ratio 1.5 [1.0, 2.3] in Post-wave 2; and 22.9 [9.2, 36.6] and 1.4 [1.1, 1.8] in Post-wave 3 respectively, P <0.001). CONCLUSION SARS-CoV-2 transmission in The Gambia during the first 3 COVID-19 waves was high, differing significantly from official numbers of COVID-19 cases reported. Our findings are important for policy makers in managing the near-endemic COVID-19.
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Affiliation(s)
- Ramatoulie E Janha
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Alasana Bah
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Hawanatu Jah
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Fatima Touray
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Yahaya Idris
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Saikou Keita
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Yassin Gaye
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Samba Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Tisbeh Faye-Joof
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Baboucarr Njie
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Rachel Craik
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, London, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Nuredin I Mohammed
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
| | - Anna Roca
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia.
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4
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Kushniruk A, Musitia PM, Mwashigadi GM, Kinshella MLW, Vidler M, Temmerman M, Craik R, von Dadelszen P, Noble JA, Papageorghiou AT. Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study. JMIR Hum Factors 2022; 9:e34823. [PMID: 36574278 PMCID: PMC9832351 DOI: 10.2196/34823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 09/27/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. OBJECTIVE The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. METHODS A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. RESULTS Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. CONCLUSIONS This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended.
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Affiliation(s)
| | - Peris Muoga Musitia
- Centre of Excellence in Women & Child Health, Aga Khan University, Nairobi, Kenya.,Health Services Unit, Kenya Medical Research Institute Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | | | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Marleen Temmerman
- Centre of Excellence in Women & Child Health, Aga Khan University, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Rachel Craik
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - J Alison Noble
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,Oxford Maternal & Perinatal Health Institute, University of Oxford, Oxford, United Kingdom
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- See Authors' Contributions,
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5
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Craik R, Volvert ML, Koech A, Jah H, Pickerill K, Abubakar A, D’Alessandro U, Barratt B, Blencowe H, Bone JN, Chandna J, Gladstone M, Khalil A, Li L, Magee LA, Makacha L, Mistry HD, Moore S, Roca A, Salisbury TT, Temmerman M, Toudup D, Vidler M, von Dadelszen P. The PRECISE-DYAD protocol: linking maternal and infant health trajectories in sub-Saharan Africa. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18465.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: PRECISE-DYAD is an observational cohort study of mother-child dyads running in urban and rural communities in The Gambia and Kenya. The cohort is being followed for two years and includes uncomplicated pregnancies and those that suffered pregnancy hypertension, fetal growth restriction, preterm birth, and/or stillbirth. Methods: The PRECISE-DYAD study will follow up ~4200 women and their children recruited into the original PRECISE study. The study will add to the detailed pregnancy information and samples in PRECISE, collecting additional biological samples and clinical information on both the maternal and child health. Women will be asked about both their and their child’s health, their diets as well as undertaking a basic cardiology assessment. Using a case-control approach, some mothers will be asked about their mental health, their experiences of care during labour in the healthcare facility. In a sub-group, data on financial expenditure during antenatal, intrapartum, and postnatal periods will also be collected. Child development will be assessed using a range of tools, including neurodevelopment assessments, and evaluating their home environment and quality of life. In the event developmental milestones are not met, additional assessments to assess vision and their risk of autism spectrum disorders will be conducted. Finally, a personal environmental exposure model for the full cohort will be created based on air and water quality data, combined with geographical, demographic, and behavioural variables. Conclusions: The PRECISE-DYAD study will provide a greater epidemiological and mechanistic understanding of health and disease pathways in two sub-Saharan African countries, following healthy and complicated pregnancies. We are seeking additional funding to maintain this cohort and to gain an understanding of the effects of pregnancies outcome on longer-term health trajectories in mothers and their children.
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6
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Shahil Feroz A, Afzal N, Seto E. Exploring digital health interventions for pregnant women at high risk for pre-eclampsia and eclampsia in low-income and-middle-income countries: a scoping review. BMJ Open 2022; 12:e056130. [PMID: 35135777 PMCID: PMC8830260 DOI: 10.1136/bmjopen-2021-056130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To explore digital health interventions that have been used to support pregnant women at high risk for pre-eclampsia/eclampsia (HRPE/E) in low-income and middle-income countries (LMICs). DESIGN Scoping review. DATA SOURCE EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched between 1 January 2000 and 20 October 2020. ELIGIBILITY CRITERIA The review included original research studies that were published in English, involved pregnant women at HRPE/E and implemented digital health interventions for PE/E in LMICs. DATA EXTRACTION AND SYNTHESIS Two reviewers independently completed the data extraction for each of the 19 final articles. An inductive approach was used to thematically organise and summarise the results from the included articles. RESULTS A total of 19 publications describing 7 unique studies and 9 different digital health interventions were included. Most studies were conducted in South Asia and sub-Saharan Africa (n=16). Of nine unique digital health interventions, two served the purpose of predicting risk for adverse maternal health outcomes while seven focused on monitoring high-risk pregnant women for PE/E. Both of these purposes used mobile phone applications as interface to facilitate data collection, decision making, and communication between health workers and pregnant women. The review identified key functions of interventions including data collection, prediction of adverse maternal outcomes, integrated diagnostic and clinical decision support, and personal health tracking. The review reported three major outcomes: maternal health outcomes including maternal and neonatal morbidity and mortality (n=4); usability and acceptability including ease-of-use, and perceived usefulness, (n=5); and intervention feasibility and fidelity including accuracy of device, and intervention implementation (n=7). CONCLUSION Although the current evidence base shows some potential for the use of digital health interventions for PE/E, more prospective experimental and longitudinal studies are needed prior to recommending the use of digital health interventions for PE/E.
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Affiliation(s)
- Anam Shahil Feroz
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Noreen Afzal
- Dean's Office, The Aga Khan University Medical College Pakistan, Karachi, Sindh, Pakistan
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
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7
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Bone JN, Pickerill K, Woo Kinshella ML, Vidler M, Craik R, Poston L, Stones W, Sevene E, Temmerman M, Koech Etyang A, Roca A, Russell D, Tribe RM, von Dadelszen P, Magee LA. Pregnancy cohorts and biobanking in sub-Saharan Africa: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2020-003716. [PMID: 33243854 PMCID: PMC7692823 DOI: 10.1136/bmjgh-2020-003716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background Technological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked samples with potential to enhance discovery science opportunity. Methods Inclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were screened in a three-stage process based on title, abstract and full text by two independent reviewers. The review is registered on PROSPERO (CRD42019147483). Results Fourteen SSA studies met the inclusion criteria from database searches (n=8), reference list searches (n=2) and expert input (n=4). Three studies have ongoing data collection. The most represented countries were South Africa and Mozambique (Southern Africa) (n=3), Benin (Western Africa) (n=4) and Tanzania (Eastern Africa) (n=4); including an estimated 31 763 women. Samples commonly collected were blood, cord blood and placenta. Seven studies collected neonatal samples. Common clinical outcomes included maternal and perinatal mortality, malaria and preterm birth. Conclusions Increasingly numerous pregnancy cohorts in SSA that include biobanking are generating a uniquely valuable resource for collaborative discovery science, and improved understanding of the high regional risks of maternal, fetal and neonatal morbidity and mortality. Future studies should align protocols and consider their added value and distinct contributions.
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Affiliation(s)
- Jeffrey N Bone
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Kelly Pickerill
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Rachel Craik
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - William Stones
- Centre for Reproductive Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Esperanca Sevene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique.,Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Angela Koech Etyang
- Department of Obstetrics and Gynaecology, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Anna Roca
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Rachel M Tribe
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Laura A Magee
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
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von Dadelszen P, Vidler M, Tsigas E, Magee LA. Management of Preeclampsia in Low- and Middle-Income Countries: Lessons to Date, and Questions Arising, from the PRE-EMPT and Related Initiatives. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Russell D. Harmonisation of maternal health biorepositories in sub-Saharan Africa. BMJ Glob Health 2021; 5:bmjgh-2020-004119. [PMID: 33328197 PMCID: PMC7745677 DOI: 10.1136/bmjgh-2020-004119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/22/2022] Open
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Magee LA, Strang A, Li L, Tu D, Tumtaweetikul W, Craik R, Daniele M, Etyang AK, D’Alessandro U, Ogochukwu O, Roca A, Sevene E, Chin P, Tchavana C, Temmerman M, von Dadelszen P. The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) database: open-access data collection in maternal and newborn health. Reprod Health 2020; 17:50. [PMID: 32354365 PMCID: PMC7191679 DOI: 10.1186/s12978-020-0873-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In less-resourced settings, adverse pregnancy outcome rates are unacceptably high. To effect improvement, we need accurate epidemiological data about rates of death and morbidity, as well as social determinants of health and processes of care, and from each country (or region) to contextualise strategies. The PRECISE database is a unique core infrastructure of a generic, unified data collection platform. It is built on previous work in data harmonisation, outcome and data field standardisation, open-access software (District Health Information System 2 and the Baobab Laboratory Information Management System), and clinical research networks. The database contains globally-recommended indicators included in Health Management Information System recording and reporting forms. It comprises key outcomes (maternal and perinatal death), life-saving interventions (Human Immunodeficiency Virus testing, blood pressure measurement, iron therapy, uterotonic use after delivery, postpartum maternal assessment within 48 h of birth, and newborn resuscitation, immediate skin-to-skin contact, and immediate drying), and an additional 17 core administrative variables for the mother and babies. In addition, the database has a suite of additional modules for 'deep phenotyping' based on established tools. These include social determinants of health (including socioeconomic status, nutrition and the environment), maternal co-morbidities, mental health, violence against women and health systems. The database has the potential to enable future high-quality epidemiological research integrated with clinical care and discovery bioscience.
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Affiliation(s)
- Laura A. Magee
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Amber Strang
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Larry Li
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Domena Tu
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Warancha Tumtaweetikul
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rachel Craik
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Marina Daniele
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Angela Koech Etyang
- Centre of Excellence in Women & Child Health, East Africa, Aga Khan University, Nairobi, Kenya
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ofordile Ogochukwu
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Anna Roca
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Esperança Sevene
- Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Paulo Chin
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | | | - Marleen Temmerman
- Centre of Excellence in Women & Child Health, East Africa, Aga Khan University, Nairobi, Kenya
| | - Peter von Dadelszen
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
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Craik R, Russell D, Tribe RM, Poston L, Omuse G, Okiro P, Chege D, Diatta M, Sesay AK, Cuamba I, Carrilho C, Sevene E, Flint-O’Kane M, von Dadelszen P. PRECISE pregnancy cohort: challenges and strategies in setting up a biorepository in sub-Saharan Africa. Reprod Health 2020; 17:54. [PMID: 32354368 PMCID: PMC7191687 DOI: 10.1186/s12978-020-0874-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE PRECISE is a population-based, prospective pregnancy cohort study designed for deep phenotyping of pregnancies in women with placenta-related disorders, and in healthy controls. The PRECISE Network is recruiting ~ 10,000 pregnant women in three countries (The Gambia, Kenya, and Mozambique) representing sub-Saharan Africa. The principal aim is to improve our understanding of pre-eclampsia, fetal growth restriction and stillbirth. This involves the creation of a highly curated biorepository for state of the art discovery science and a rich database of antenatal variables and maternal and neonatal outcomes. Our overarching aim is to provide large sample numbers with adequate power to address key scientific questions. Here we describe our experience of establishing a biorepository in the PRECISE Network and review the issues and challenges surrounding set-up, management and scientific use. METHODS The feasibility of collecting and processing each sample type was assessed in each setting and plans made for establishing the necessary infrastructure. Quality control (QC) protocols were established to ensure that biological samples are 'fit-for-purpose'. The management structures required for standardised sample collection and processing were developed. This included the need for transport of samples between participating countries and to external academic/commercial institutions. RESULTS Numerous practical challenges were encountered in setting up the infrastructure including facilities, staffing, training, cultural barriers, procurement, shipping and sample storage. Whilst delaying the project, these were overcome by establishing good communication with the sites, training workshops and constant engagement with the necessary commercial suppliers. A Project Executive Committee and Biology Working Group together defined the biospecimens required to answer the research questions paying particular attention to harmonisation of protocols with other cohorts so as to enable cross-biorepository collaboration. Governance structures implemented include a Data and Sample Committee to ensure biospecimens and data will be used according to consent, and prioritisation by scientific excellence. A coordinated sample and data transfer agreement will prevent delay in sample sharing. DISCUSSION With adequate training and infrastructure, it is possible to establish high quality sample collections to facilitate research programmes such as the PRECISE Network in sub-Saharan Africa. These preparations are pre-requisites for effective execution of a biomarker-based approach to better understand the complexities of placental disease in these settings, and others.
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Affiliation(s)
- Rachel Craik
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | | | - Rachel M. Tribe
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Geoffrey Omuse
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Patricia Okiro
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - David Chege
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Mathurin Diatta
- Medical Research Council Unit (The Gambia) at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Abdul Karim Sesay
- Medical Research Council Unit (The Gambia) at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Department of Physiological Science, Clinical - Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Esperança Sevene
- Centro de Investigacão em Saúde de Manhiça, Maputo, Mozambique
- Department of Physiological Science, Clinical - Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Meriel Flint-O’Kane
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter von Dadelszen
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
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