Multidisciplinary sickle cell disease obstetrics care program in ghana: non-academic VS.academic hospital (pilot study) - with increasing life expectancy in africa, pregnancy has become an emerging…

Multidisciplinary sickle cell disease obstetrics care program in ghana: non-academic VS.academic hospital (pilot study) - with increasing life expectancy in africa, pregnancy has become an emerging life-threatening complication in SCD women. In low and middle-income countries, the odds ratio of maternal death associated with SCD is 22.81, 95% CI 14.67-35.46.1 from 2012-2014, the obstetrics department, korle-BU teaching hospital (KBTH), accra, ghana, established an obstetrician-led SCD obstetrics (OB) clinic. The institutional maternal mortality for SCD over these three years (2012-2014) was approximately 12%. In january 2015, a multidisciplinary SCD OB team was established. The team conducted a combined retrospective/ prospective case series of all maternal deaths in women with SCD at KBTH over seven years (2010-2016).2 this retrospective data collection highlighted failures and challenges to delivering improved care. Acute chest syndrome, preceded by acute pain episodes, was the leading cause of death in nearly 87% of women.2 in may 2015, the team implemented a joint obstetrics/ hematology clinic, instituted close maternal and fetal monitoring, and implemented clinical guidelines/ protocols. In addition, the SCD OB team established a weekly communication system to adjudicate the management of challenging cases. These interventions resulted in an 89.1% risk reduction in maternal mortality (from 10,791 to 1,176 deaths per 100,000 live births; P=0.007) over 13 months.3 since initiating our multidisciplinary SCD OB program, we have consistently decreased maternal mortality in this cohort by approximately 90% compared to before the team was established.4,5 this physician-mentored application aims to conduct an effectiveness-implementation feasibility study to extend our results of decreasing maternal mortality from an academic hospital to a non- academic hospital setting in accra, ghana with a current maternal mortality rate of 5,940 deaths/ 100,000 live births in SCD women. Over five years, the applicant will acquire the skills to use the consolidated framework for implementation research (CFIR)6 and the RE-aim framework (reach, effectiveness, adoption, implementation, and maintenance)7 to inform the stages of the study. The applicant will test the hypothesis that " in a before and after study design, the applicant will test the hypothesis that multi- disciplinary care and task-shifting in a non-academic hospital for pregnant women with SCD will have an 80% relative risk reduction in death compared to the mortality rate in the same hospital before the multi-disciplinary medical care." the specific aims for this mentored award are: 1) identify contextual determinants (barriers/ facilitators) that influence the adaptability of the evidence-based practice for establishing a multidisciplinary SCD OB team as an intervention in the non-academic hospital, including the implementation process (years 1-2); 2) build capacity for a multidisciplinary SCD OB program in a non- academic hospital (years 3-5), and 3) conduct a hybrid type 1 feasibility study comparing the effectiveness of a task-shifted multidisciplinary SCD OB program in a non-academic site (years 3-5).