Bridget Griffith, MPH PhDc
Nominated From: University of Minnesota
Research Site: Uganda
Research Area: Maternal and Child Health/Emergency Medicine
Primary Mentor: Nicole Basta
Expectant mothers and medical emergencies: Opportunities for improved outcomes in Uganda
In 2015, the Ugandan government announced a “zero tolerance on maternal mortality” campaign, with the goal of zero maternal deaths by 2020. Maternal mortality, defined as any death within 42 days of delivery or termination of pregnancy not due to incidental or accidental causes, occurred in 343 per 100,000 live births in Uganda in 2015, compared to the global average of 215 per 100,000[1, 2]. This is within a region that bears 66.3% of the globe’s maternal mortality, an estimated 546 deaths per 100,000 live births in 2015[3, 4]. There is great opportunity to enhance maternal care services throughout the Ugandan health system, including opportunities to ensure that acute and emergency services are meeting the needs of pregnant women. Since many of the indirect causes of maternal mortality are due to acute conditions, the bulk of prevention is accomplished with acute medical care throughout pregnancy and not only at time of birth. Therefore, characterizing the medical care patterns of pregnant and postpartum women is key to determining both the burden and source of direct and indirect causes of maternal morbidity and mortality, along with identifying opportunities for intervention to reduce negative outcomes[6, 7].
Conducting this research onsite in Uganda is critical, because this project explores a previously undefined aspect of the maternal health system. Literature on emergencies in pregnancy often excludes non-obstetric emergencies, such as malaria, HIV-related complications, and acute disease. Furthermore, evidence from east Africa is lacking. A study by Osei-Ampofo et al. in another low-income, tertiary, urban hospital in Ghana found that 1.1% of injury-related emergency patients were pregnant. Within that group of injured pregnant women, the prevalence of poor fetal outcomes was high. Our study goes beyond this approach by drawing on two unique datasets that include pregnant and postpartum women from all hospital wards and all emergencies, whereas Osei-Ampofo et al. only includes injured patients that presented at the emergency department. Furthermore, this study will include an interview portion, which should generate information that differs from what is available in a medical chart. This study will also compare information across both urban and rural hospital sites, which is particularly relevant because over 80% of Ugandans live in rural communities.
Quantifying the burden caused by acute and emergency conditions of pregnant women has the potential to inform the improvement of practices and infrastructure within in the African emergency and acute care system and maternal health delivery system by generating novel information about the nature of these conditions while also understanding the factors that lead to these emergencies. Furthermore, this information can help inform the prioritization of health policies, programs, funding, and targeted interventions to reduce maternal deaths at both regional and global levels.
1a: Describe the emergency care seeking patterns of pregnant and postpartum women in Uganda.
1b: Compare the burden of conditions requiring emergency medical care across three geographically distinct facilities in urban, peri-urban, and rural areas. We will digitize abstracted medical chart data from women presenting at the urban Mulago Hospital and analyze these data with the peri-urban and rural hospital dataset, which is composed of information from the hospitals’ emergency department quality assurance (QA) database and 3-day follow up survey, to quantify the burden of conditions that require emergency medical care. We will also assess the outcomes to understand which conditions contribute the greatest to maternal mortality.
Our analysis of data from these two sources will provide comprehensive data to determine the causes that lead pregnant and postpartum women to seek emergency care and how these causes contribute to maternal mortality in distinct healthcare settings with varying levels of services and resources. By conducting analyses across these datasets, we will identify differences in the burden of maternal emergencies in urban vs. rural settings and private vs. public hospitals, which can lead to more tailored preventative interventions.
2: Understand the multiple causes and context of emergencies throughout the pregnancy and postpartum period among women in a both rural and urban low-income settings with limited access to emergency and acute care and how women interact with the healthcare system during an emergency.
We will conduct key informant interviews of healthcare workers (HCWs) who deliver care for emergencies in pregnancy or the postpartum period at the three hospital facilities included in the datasets under Aim 1. Commonly occurring clinical patterns that arise from the analysis in Aim 1 will guide the themes of questions asked during the key informant interviews. This data will be analyzed to determine underlying reasons and clinical patterns that contribute to maternal morbidity and mortality that cannot be abstracted from medical charts. We anticipate that insight gained from these interviews will complement the quantitative analyses under Aim 1, allowing us to both interpret those data in context and develop targeted preventative intervention strategies to reduce the burden of maternal morbidity and mortality from emergencies in pregnancy.
- Dr. Nicole Basta, School of Public Health, Division of Epidemiology and Community Health, University of Minnesota
- Dr. Annettee Nakimuli, Makarere University, Kampala, Uganda
- Dr. Imelda Namagembe, Makerere University, Mulago Hospital, Kampala, Uganda
- Dr. Mark Bisanzo, College of Medicine, University of Vermont