KAMPALA/UGANDA: A new study in Uganda has generated a predictive model with the potential to save millions of pregnant mothers who die from a pre-natal hypertensive condition known as “Pre-Eclampsia.”
The research study titled: “Prediction of pre-eclampsia at St. Mary’s hospital Lacor, a low-resource setting in northern Uganda, a prospective cohort study,” was carried out at St. Mary’s Lacor Hospital in the northern Uganda city of Gulu by Silvia Awor from the Department of Obstetrics and Gynaecology, Faculty of Medicine, Gulu Gulu University in Northern Uganda.
The hospital receives about 3,600 antenatal mothers and conducts about six thousand deliveries annually. Some mothers go to the hospital for delivery without prenatal care; others are referred from smaller health units.
Her objectives were to determine the characteristics that predict pre-eclampsia and adverse pregnancy outcomes such as over bleeding and pre-natal deaths.
Her study was motivated by the fact that over the last decade, maternal and perinatal mortality in Uganda has remained unacceptably high, yet some of the causes are preventable if detected or predicted early.
She was further motivated by the realization that routine screening and prediction for the major causes of maternal and perinatal mortality are incorporated into prenatal care in the global north, measures that lacking in the global south where countries like Uganda are situated.
What is Pre-eclampsia?
Pre-eclampsia, is a pregnancy syndrome, is characterized by hypertension and proteinuria. Approximately 90 percent of cases are present in the late preterm (usually around 34 weeks) period and have good maternal and fetal outcomes. It remained the second leading cause of maternal death in Uganda.
Awor observes from her study that 10 percent of cases who have an early presentation (34 weeks) have more severe disease and carry the additional high risks associated with preterm birth. In addition, she adds, mothers with a history of pre-eclampsia are at increased risk for developing cardiovascular and renal disease.
Risk factors include low socio-economic status, nulliparity, multiple pregnancies, obesity, chronic hypertension, being a woman of African descent, previous maternal or family history of pre-eclampsia, and maternal age of 35 years
In her paper which has been published in the prestigious BMC Pregnancy and Childbirth Journal, she counsels that in prenatal clinics where pre-eclampsia is predicted, early diagnosis and appropriate treatment can be made to save lives, hence her move to develop predictive models
To prevent this crisis in the country’s hospitals, Awor’s study has helped develop and validate prediction models for prenatal screening for pre-eclampsia because many Ugandan mothers report to the hospitals late due to healthcare challenges and some end up dying in the process.
She used synthetic data to validate the models and they performed very well.
“When a mother comes to the prenatal clinic with all or some of the characteristics (predictors) in the models, they are to be referred to specialist health care providers. These providers are supposed to monitor them more closely. If antenatal visits are done monthly, these patients will probably be checked every two weeks or weekly until they deliver. The point is to catch the disease earlier, and deliver the baby to prevent the disease from progressing to kill the mother,” she says of her models.
The Study:
The research was a prospective cohort study at St. Mary’s Hospital Lacor, a private, not-for-profit hospital founded by the Catholic Church.
St. Mary’s hospital Lacor receives approximately three thousand six hundred antenatal mothers annually. Since the study duration was 24 months, the limited population that could be accessed was about 7,200 mothers.
The study used consecutive sampling in which mothers were informed about the study during their morning health education meetings
All the women who satisfied the inclusion criteria were approached and requested to provide informed consent. Some mothers were asked to give blood samples for full haemograms and liver and renal function tests.
In all, 1,285 pregnant mothers who were aged 16–24 weeks from April 2019 to March 2020, were recruited. They were then followed up until September 2020. From here, 1,004 complete delivery records were obtained at the end of the study period in which 782 participants had laboratory blood tests done in addition to blood pressure readings, body mass index calculation, and maternal history.
The models:
The study has generated six models after thorough statistical modeling. Combined, the models, with significant accuracy, revealed that predictors of pre-eclampsia were maternal age, parity, personal history of pre-eclampsia, body mass index, diastolic pressure, multiple pregnancies, white blood cell count, lymphocyte count, serum alkaline phosphatase, serum albumin, and serum urea and personal history of pre-eclampsia.
“These models are preventive. We should now be able to prevent death through early detection and treatment/ delivery,” Awor reveals.
Exuding confidence, Awor assures Uganda mothers; “Of course the model is a positive step towards a cure. Because we have to know who gets pre-eclampsia before they get it before we start working around the clock to find a cure.”
She adds that her prediction models can be adapted for use in prenatal clinics to screen mothers for the prediction of pre-eclampsia. In addition, data from such clinics can be used to validate the models.
“This study will significantly benefit pregnant mothers, caretakers, and healthcare providers in deciding who to monitor more closely and have a timely referral to higher-level health units,” she says.
She adds that if such models were incorporate screening for preeclampsia, for instance, use model 1 (maternal history and physical examination at Health Centres 1, 2, and 3, while models 3, 5, and 6 are used in higher-level health centers depending on the expertise available, many lives would be saved.
The study’s Journey:
Silvia Awor, currently a Ph.D. student, wrote the proposal, collected data, and drafted the manuscript. She was assisted by scientists who are based at three public universities in Uganda, namely; Makerere University, Gulu University, and Lira University. Scientist Benard Abola built the models and cross-validated the models. Prominent scientists Doctors Rosemary Byanyima, Paul Kiondo, and Christopher Garimoi Orach, provided expert opinions and guided Silvia in writing the manuscript. Doctors Annettee Nakimuli, Jasper Ogwal-Okeng, and Dan Kabonge Kaye were her doctoral supervisors who guided her through the concept and writing of the manuscript.
The research was funded as a Ph.D. project by the Swedish International Development Agency (SIDA) under the Makerere University – SIDA bilateral agreement.
EDITOR’S NOTE: for a more detailed analysis of these models, readers can access Awor’s paper here https://bit.ly/3Z9ChzC or, reach her by Phone Number +256 782841168 and Email Address s.awor@gu.ac.ug
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He Is A Longtime Journalist In Uganda Who Has Served As A Cab Reporter And Later On As Bureau Chief At Daily Monitor Newspaper From 1999 To 2001. In June 2001, He Co-Founded Uganda’s First English Tabloid Newspaper, Red Pepper Where He Has Served In Various Capacities From Managing Editor To Advertising Director, Ending His Career As Marketing And Digital Media Director In 2020.
A Holder Of A Master Of Science In Marketing From Salford University And Currently A Ph.D. Fellow In Journalism And Communication At Makerere University, Rugyendo Is A Desmond Tutu Fellow, Crans Montana New Leader, And Chairman Of Young Engineers Uganda And Uganda Premier League.
