January 31, 2019

Saving Lives at Birth Grand Challenges Canada has awarded the nonprofit organization Kybele-Ghana $491,480 to scale up an innovative triage system to high-risk obstetric hospitals. Funds matched by other contributors will bring the two-year award to $984,069.

Dr. Rohit Ramaswamy

Dr. Rohit Ramaswamy

Rohit Ramaswamy, PhD, professor in the Public Health Leadership Program and in the Department of Maternal and Child Health at the UNC Gillings School of Global Public Health, is one of the four interdisciplinary project leaders. He will be responsible for developing and evaluating the project’s implementation strategy.

The Saving Lives at Birth challenge calls on the brightest minds to identify and extend transformative prevention and treatment approaches for pregnant women and newborns around the world. The 2018 challenge drew 500 applications, and 10 finalists were shortlisted. Finalists presented groundbreaking solutions that dramatically could reduce maternal and newborn mortality. From these, four projects were selected to negotiate awards.

The proposal developed by Ramaswamy and a team from Kybele and the Ghana Health Service emphasized the need both for an effective clinical intervention and a viable implementation strategy. Medge Owen, MD, founder of Kybele and project co-lead, is adjunct professor in the Gillings School’s Public Health Leadership Program.

The program leverages collective resources of the United States Agency for International Development (USAID), Norwegian Agency for Development Cooperation (Norad), the Bill & Melinda Gates Foundation, Grand Challenges Canada (funded by the Government of Canada), the U.K.’s Department of International Development (DFID) and the Korea International Cooperation Agency (KOICA).

According to the World Health Organization, about 319 maternal deaths per 100,000 live births occur in Ghana, a rate thirteen times higher than in the U.S. While institutional delivery is seen as a way to reduce poor pregnancy outcomes, few initiatives address the long delays women face when arriving at the hospital. In Ghana, childbirth facilities operate on a first-come, first-served basis, leading to days-long treatment delays for women who present with dangerous conditions such as hemorrhage and preeclampsia.

The obstetric triage system, designed to reduce waiting time and prioritize treatment for high-risk obstetric patients and neonates, was developed by a multidisciplinary team of clinicians, implementation scientists and Ghana Health Service leaders to ensure that the clinical innovation was integrated into the health system and was acceptable to local staff. The Greater Accra Regional Hospital, which hosts 7,000 to 8,000 births each year, was selected as the pilot site.

Patient waiting time from arrival to evaluation decreased from 40 minutes to five minutes with improved treatment strategies.

The award to Kybele-Ghana will allow the pilot to be scaled up to other high-volume referral hospitals across Ghana, with the goal of developing independent, self-supporting obstetric triage systems. The program will ensure rapid assessment for all women, prompt prioritization of women at risk, and the establishment of risk-appropriate, evidence-based, high-quality care plans.

Ramaswamy will work with a Gillings School graduate student on the project. Several UNC public health graduate students have been involved in previous stages of the project and have co-authored a number of publications on the work.

“We are excited about the change these efforts can make in the lives of women and newborns across Ghana – and about the ability to apply implementation science methods to an important global health problem,” Ramaswamy said. “At the Gillings School, we are known for our ability to apply science to solve complex problems, and this project is a perfect example both of our expertise and our commitment to global health.”


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