Addis Ababa University (AAU)-Emory University Academic Health Center Partnership Program

Addis Ababa University (AAU)-Emory
University Academic Health Center
Partnership Program
Yirgu G. Hiwot, M.D.
Professor of Obstetrics and Gynecology
Faculty of Medicine, AAU
Henry M. Blumberg, M.D.
Professor of Medicine and Epidemiology
Division of Infectious Diseases
Emory University School of Medicine
High Maternal Mortality in Ethiopia
• Maternal Mortality Ratio in Ethiopia: 590 per 100,000 live
births
• Ethiopia is one of 6 countries that accounts for >50% of
all global maternal deaths (Hogan MC. Lancet 2010)
• Pre-eclampsia /Eclampsia is the leading cause of
maternal mortality in Addis Ababa and one of the top
5 causes in Ethiopia
• No availability of magnesium sulfate in Ethiopia (drug
of choice for treatment for pre-eclampisa/eclampsia)
MgSO4 on WHO List of Essential Medications and
inexpensive
AAU-Emory Collaboration
Improving Maternal Health
• Pre-eclampsia and eclampsia: hypertensive
disorders of pregnancy
Pre-eclampsia: elevated blood pressure plus
proteinuria
Eclampsia: seizures + pre-eclampsia
Complications: stroke, renal failure, ARDS, DIC, death;
also contributes to neonatal morbidity/mortality
AAU-Emory Collaboration
Improving Maternal Health
• Substantial data that MgSO4 is drug of choice for
pre-eclampsia and eclampsia
• Compared to diazepam (Valium), MgSO4 is
associated with
Reduction in maternal death (59%)
Reduction in progression from pre-eclampsia to
eclampsia
Reduction in risk of recurrence of further seizures (44%)
MAGPIE Trial Lancet 2002; Cochrane Database Syst Rev 2003
AAU-Emory Partnership
Improving Maternal Health/MDG 5
• Project Proposed by AAU faculty; Consensus
on Project for UM/Gates Pilot Grant:
Implementation of the use of MgSO4 for the treatment of
pre-eclampsia /eclampsia at 3 AAU Teaching Hospitals
1000 deliveries per month at these hospitals
(8-10% estimated to have pre-eclampsia/eclcampsia)
Enthusiasm at MOH and others
• Currently no availability and no use of MgSO4
for the treatment of pre-eclampisa/eclampsia in
Ethiopia; diazepam has been used
Science 2007; 318:1728
Nature 2008;453:840
AAU-Emory Collaboration
Improving Maternal Health
Specific Aims
1. Conduct a KAP survey of health care providers at the
3 AAU teaching hospitals prior to (baseline) and after
implementation of MgSO4
2. Implement the use of MgSO4 for the treatment of
pre-eclampsia/eclampsia at 3 AAU teaching hospitals
3. Determine the proportion of patients who appropriately
receive MgSO4 and assess outcomes compared to
baseline period before availability of MgSO4
 Reduction in progression to eclampsia (seizures)
 Impact on maternal morbidity and mortality
 Impact on neonatal outcomes
Progress/Timeline
Activity
Comment
Date (2010)
Protocol Development
MAGPIE [Lancet 2002],
Pritchard [1984]
Feb-March
KAP Survey
development
Developed by AAUEmory partnership; no
validated survey existed
Feb-March
KAP Administration
20 OB/GYN faculty, 70
OB/GYN housestaff,
80 medical students;
nursing staff on OB
Developed surveillance
system for pre-clampsia/
eclampsia
REDCap
Late AprilMay
(evidenced based)
Data Collection Form
Database construction
Feb-March
Feb-March
Progress/Timeline II
Activity
Comment
Date (2010)
Educational materials -Pocket Card for HCWs April,
Educational
Interventions
Procurement
-Poster for L&D with
MgSO4 protocol
-Use of MgSO4 protocol
-ESOG (Ethiopian Society
of OB/GYN) collaboration
-Dr. Yirgu (AAU), Mark
Adelman (Emory MS4)
invited to talk at ESOG
-Training of OB Chief
Residents
MgSO4 (?UNICEF)
Calcium Gluconate
ongoing
May-June
May 1 Conf
Pending
Dashboard: Impact of AHC Partnerships
1. How does an African medical school influence public
policy, impact health programs?
• Implementation of MgSO4 by 3 AAU teaching
hospitals can serve as pilot/model for subsequent scale
up/role out of MgSO4 use at 115 hospitals in Ethiopia
(UNICEF, MOH, ESOG)
• Development of protocol, educational
materials leveraged for country-wide use in
collaboration with UNICEF, MOH, ESOG
• Overcoming procurement and other challenges:
through public-private partnership (UNICEF, MOH,
ESOG, AAU-Emory AHC partnership)
Dashboard: Impact of AHC Partnerships
2. To what extent is the African medical school
generating new knowledge relevant to health
systems through evaluation, research, and
development of research capacity?
Science 2007; 318:1728
• Research to optimize
scientific advances and
facilitate their adoption in
the real world
Other Activities and Benefits
• Infectious Diseases (ID) Training
Program Collaboration supporting new
AAU/Black Lion ID fellowship
• AAU, Emory, McGill
Johns Hopkins
• Teaching on Internal
Medicine and ID services
Emory Team at AAU
in
in March 2010
Collaborative ID fellow
(AAU-Emory) research
North America visit
/Black Li
• KAP—Cervical Cancer/
Screening
• Emergency Medicine
collaboration (May 2010)
Tikur Anbessa
(Black Lion) Hospital
• Other Departments
Emergency Dept
Acknowledgements
• Miliard Derbew, M.D. (Dean, Faculty of Medicine, AAU)
• Sara Haile, MPH (Coordinator, International Activities,
AAU)
• Jeffrey Koplan, MD, MPH (Emory Global Health Institute)
• Mark Adelman (Emory 4th year medical student)
• Jennifer Goedken, MD (Emory OB/GYN Dept)