Capacity Research Innovation Building maternity Systems in Sierra Leone (CRIBS)

To do this the research team have created a programme of work in collaboration with research colleagues and implementing partners in Sierra Leone in order to build new research capacity, which is currently underdeveloped, and to develop existing research projects related to the evaluation and implementation of novel life-saving interventions.

What is the health problem?

In Sierra Leone 1 in 17 women die in pregnancy. It is one of the most dangerous places in the world to give birth, with nearly half of the deaths occurring in adolescents, due to poor access to care. When a mother dies, her child is 10 times more likely to die within the first two years. We have shown that three quarters of women die from bleeding, infection or blood pressure problems, all of which can be identified by measuring blood pressure and heart rate, and are preventable with simple, cheap interventions.

But Sierra Leone lacks monitoring equipment and training which means that women lack timely, lifesaving care. Our new NIHR Global Health Research Group, CRIBS (Capacity. Research. Innovation. Building maternity Systems) builds on research partnerships spanning the last five years in Sierra Leone, formalising the collaboration between King’s College London and the University of Sierra Leone, and is led in the UK by Professor Andrew Shennan and in Sierra Leone (SL) by Prof Sahr Gevao, in collaboration with many partners, including the Ministry of Health and Sanitation (MoHS) in SL, led by Dr Sartie Kenneh, iNGO Welbodi Partnership led by Dr Venetia Goodhart, Lifeline Nehemiah Project led by Prince Tommy Williams, and the National Midwifery Schools led by Dr Joan Shepherd.

Programme aims

The research team plan to develop and implement simple, scalable innovations to reduce maternal and perinatal mortality and build research capacity and expertise in Sierra Leone.

About the research team

The research group is multidisciplinary and includes King’s College London (KCL) researchers: Prof Andrew Shennan, Prof Jane Sandall, Prof Lucy Chappell, Dr Andrew Leather, Dr Kate Bramham, Dr Harriet Boulding, Mr Paul Seed, Dr Alex Ridout, Dr Cristina Fernandez Turienzo, Dr Katy Kuhrt and Lucy November alongside our Sierra Leonean Midwifery, Dr Joan Shepherd and obstetric colleagues, PhD student Dr Francis Moses, and gender studies specialist and PhD student Mangenda Kamara.

How the project will be carried out

Research methods will include: hybrid cluster trials, observational studies, surveys, semi-structured interviews, focus group discussions and photovoice – a visual research methodology.

The main work streams include:

1) Evaluation of the CRADLE Vital Signs Alert (VSA) Monitor throughout the country, (where outcomes are worse and treatment most challenging), leading to earlier detection of women who are deteriorating secondary to common pregnancy related problems (for example Shock Index also measured by the CRADLE VSA, and a test to identify kidney failure);

2) Introduction and evaluation of a locally designed and community-based intervention targeted to pregnant teenagers, to improve access to care and education, and to better understand how blood pressure problems affect the health of this group of pregnant women;

3) An evaluation of how cost effective it would be to introduce the CRADLE VSA and related interventions at scale in Sierra Leone, and the pathways to dissemination by government

4) Building local research capacity through supervision of three PhD students (in the area of implementation science, health policy and health economics), inclusion of research training into National School of Midwifery Curriculum and mentoring for medic/midwife academics, and creation of Sierra Leone's first Patient and Public Involvement Initiative to give women and community members in Sierra Leone a new voice.

How patients and the public are involved

The CRIBS group will be guided by the community engagement and involvement (CEI) experience of our partners. Welbodi Partnership have over 12 years’ experience delivering complex health system strengthening programmes and have strong relationships with the Ministry of Health and Sanitation (MOHS), NGO and UN, educational institutions, healthcare providers, community leaders and members; and Lifeline Nemeniah Project, a community based solutions NGO, with unique skills in community engagement and has worked with the MOHS for many years. The National Quality Management Programme at the MOHS acknowledges the need to increase CEI, which is key to build trust and empower service users in the process of health service delivery. We will work together to formalise existing partnerships and ensure the research and CEI activities empower women and their support networks to have control over decisions that most affect their lives, and are aligned with community and national priorities

CEI activities for this programme will include:

• initial engagement events for local community leaders
• site initiation workshops for the local community and healthcare providers using participatory action research techniques (e.g. social mapping, picture codes, spider-grams, use of structured life narratives or stories)
• co-development of culturally appropriate materials and infographs
• provision of programme newsletters and regular study progress updates
• interviews and focus groups with pregnant women, care providers and study champions
• informal feedback via WhatsApp groups
• dissemination events with local, national and international research community and public
• a community engagement strategy and a case study will also be co-developed, published and disseminated.

Potential benefits of the project

Potential benefits of the project include a reduction of maternal and perinatal mortality, improvements in health and wellbeing and the development of local research capacity and expertise.

This project is funded by the NIHR  and was adopted by ARC South London in November 2021. It will be completed by September 2021.