Through both implementation science and discovery research, PTBi East Africa is focused on reducing the burden of prematurity in Western Kenya, Eastern Uganda, and Rwanda. Our goals are to improve knowledge of preterm birth, to reduce neonatal mortality due to prematurity, and to improve quality of care during the antenatal, intrapartum and immediate postnatal periods. We are committed to promoting relationships between East African and UCSF investigators, developing new talent, and building research capacity in the area of prematurity.
A focus on discovery research
Led by East African investigators, we pursue research that will improve our knowledge of preterm birth and contribute to the development of tools to predict, prevent, and manage prematurity in our settings. This includes:
- The interplay of biological causes and mechanisms of risk factors, such as infection, inflammation, nutrition, stress, and environmental toxins
- Innovative strategies and tools to better manage the intrapartum/postnatal period, to improve clinical decision-making, and to predict newborn complications
- Relevant strategies, tools and technologies to improve surveillance of preterm birth and its outcomes, especially improving accurate gestational age assessment and follow-up to 28 days
More accurate assessment of gestational age
Gestational age assessment is often unreliable, leading to the inability to properly manage a complicated delivery or care for a baby born too soon.
Gestational age describes how long a pregnancy is, and is measured from the first day of the last menstrual period (LMP) to the current date (or, for preterm babies, their day of birth). This information is important for mothers who want to know when to expect their babies and how to best care for their child during pregnancy. Also, gestational age is critical for providers, so that they can make the safest and most effective decisions about care.
If a baby is born prematurely, knowing his or her gestational age is particularly important and will inform the best type of care that baby receives. However, gestational age can be hard to determine: many places lack access to early ultrasound technology, women have difficulty recalling their LMP, providers often measure fundal height inconsistently, and many facilities have various data quality issues. Are there new innovations to more accurately capture gestational age throughout pregnancy and at birth?
Together with the Bill and Melinda Gates Foundation, PTBi-EA is working to validate a new tool that accurately predicts gestational age. This tool was initially developed using newborn heel stick samples from a cohort of 700,000 California babies, and identifies term versus preterm newborns with >95% accuracy, as well as assigns gestational age within two weeks for 90% of newborns. Researchers are testing this algorithm on more than 800 newborns and existing banked biospecimens in Tororo, Uganda.
Improving care for preterm infants
Up to three-quarters of preterm infants can be saved with existing evidence-based interventions. Can novel, innovative strategies or technologies improve scale-up of key practices around feeding, breathing and warming? NoviGuide is a tablet-based training and decision-support tool, designed to optimize facility-based care of newborns in resource-limited settings. NoviGuide translates WHO and country neonatal care guidelines into case-specific clinical instructions. Researchers are testing whether NoviGuide can streamline decision-making and reinforce skills learned in standard training among nurses and midwives in a rural Ugandan hospital.