Background: Women in sub-Saharan Africa have the highest rates of morbidity and mortality during childbirth. Despite significant increases in facility-based childbirth, quality gaps at the facility have limited reductions in maternal deaths. Infrequent monitoring of women around childbirth is a major gap in care that leads to delays in life-saving interventions. Simple increases in staffing will not overcome this gap, thus necessitating new strategies. Wireless physiologic monitoring has been shown to be feasible in resource-limited settings; I hypothesize that this innovative approach to physiologic monitoring will facilitate early clinical detection of critically ill women in the first 24 hours after childbirth, thus providing the opportunity for disability-averting and lifesaving interventions. Candidate: My career goal as an academic obstetrician-gynecologist (OB/GYN) is to become an independent R01-level investigator with expertise in developing, testing, and implementing innovative strategies to improve maternal and newborn outcomes during facility-based childbirth in resource-limited settings. My goals are motivated by early experiences during my upbringing in Ghana and Zambia, and strengthened from clinical experience as a trainee and junior faculty in Ghana and Zambia. My background, training in OB/GYN, early research track record with 8 first-author publications, and successful pilot and prospective work in Uganda make me well-poised to undertake the proposed research and training. Training/Mentoring: To achieve my career goal, I require further training in clinical trial design, implementation science and qualitative methods. I will be supported with a team of experts led by Dr. Haberer (primary mentor), an NIH-funded investigator with extensive mentoring experience, protected time through a K-24, and an acclaimed portfolio of research in resource-limited settings. Drs. Wylie (OB/GYN, clinical trials), Metlay (implementation science), Psaros (qualitative methods) and Ngonzi (OB/GYN, Uganda site) will provide additional mentorship in my training aims. Research: Using a hybrid clinical effectiveness-implementation approach I will enroll 530 women delivered by cesarean to wear a wireless physiologic monitor for 24 hours after delivery. Their delivering obstetricians will be recruited to use the monitoring system, including the receipt of text message alerts should women develop abnormalities in physiologic signs. I will measure rates of morbidity and mortality and compare these with a control group of women delivered by the same obstetricians. I will use the RE-AIM implementation science framework to assess clinical adoption. I will perform semi-structured interviews with postpartum women and obstetricians to understand acceptability and explore facilitators and barriers to use of a wireless physiologic system in a resource-limited setting. My comprehensive training program, supported by a strong team of mentors, and combined with an innovative research proposal position me well to develop into a successful independent investigator with expertise in testing and implementing innovative strategies to improve the safety of facility-based childbirth in resource-limited settings.
Women in sub-Saharan Africa continue to face unacceptable levels of death and disability during childbirth, even when delivering at a health facility. Close monitoring during childbirth is a critical component of preventing death and disability. This project aims to use a simple wireless monitor to improve the detection of complications immediately after childbirth and allow clinicians to provide life-saving interventions when needed.
