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GLOBVAC-Global helse- og vaksin.forskn

PRESHA Project - PREventing Severe Hypertensive Adverse events in pregnancy and childbirth

Alternative title: PRESHA Prosjekt - Forebygging av alvorlig utfall relatert til svangerskapshypertensjon

Awarded: NOK 12.0 mill.

Globally 76 000 women and 500 000 infants die each year due to Preeclampsia (PE). Early identification of women at risk and timely prevention and treatment of PE will greatly reduce maternal and perinatal death and disability, a core priority in the Sustainable Development Goals. Global guidelines and models for risk-screening, prevention and management of Preeclampsia exist. However, several health system barriers impact their implementation in low-resource settings. Risk screening for PE in early pregnancy is possible through measurement of biomarkers. This will allow for efficient resource allocation and targeted prevention strategies. The PRESHA project aims to prevent maternal and perinatal death and disability due to PE in Low- and Middle-Income Countries through improved prediction, prevention, and clinical management. The project team lead is the Department of Community Medicine and Global Health, University of Oslo, Norway. Partners are the Oslo University Hospital, Norwegian National Advisory Unit on Women’s Health in Norway, the departments of Research and Publication and department of Public Health at the Catholic University of Health and Allied Sciences in Mwanza, Tanzania. The Dutch Partner is the Department of Epidemiology at the Julius Center Research Program Cardiovascular Epidemiology, Utrecht University, the Netherlands. The PRESHA Project is unique in combining the promotion of novel technologies with strengthening the organization of existing care processes. We will use an innovative combination of disciplines and methodological approaches to increase knowledge on the existing implementation challenges and co-create, implement, and evaluate a package of interventions for prevention and management of PE, that is adapted and relevant to the Tanzanian context. Through process, impact and cost-effectiveness evaluations we will examine how this complex intervention can be implemented successfully in Tanzania and translated to other settings.

Globally 76 000 women and 500 000 infants die each year due to Pre Eclampsia (PE). Early identification of women at risk and timely prevention and treatment of PE will greatly reduce maternal and perinatal death and disability, which is a core priority in the Sustainable Development Goals. Global guidelines and models for risk-screening, prevention and management of PE exist. However, several health system barriers impact their implementation in low-resource settings. These include sub-standard quality of antenatal care, lack of risk screening tools and delays in referral. Risk screening for PE in early pregnancy is possible through measurement of biomarkers (such as PlGF/sFlt-1). This will allow for efficient resource allocation and targeted prevention strategies including aspirin and calcium supplementation and timely referral if needed. The PRESHA Project is unique in combining the promotion of novel technologies (Point of Care tests for biomarkers) with strengthening the organization of existing care processes. The PRESHA project is an interdisciplinary, mixed-method intervention study with three phases: (I) pre-implementation (II) implementation in the participating clinics/hospitals, and (III) post-implementation evaluation. We will use an innovative combination of disciplines and methodological approaches to increase knowledge on the existing implementation challenges and co-create, implement, and evaluate a package of interventions for prevention and management of PE, that is adapted and relevant to the Tanzanian context. This is in line with strategies formulated by the Tanzanian Ministry of Health and Social Welfare. Through process, impact and cost-effectiveness evaluations we will examine how this complex intervention can be implemented successfully in Tanzania and translated to other settings.

Funding scheme:

GLOBVAC-Global helse- og vaksin.forskn