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Setting a global dragnet for pre-eclampsia
August 19 , 2011
When the United Nations laid out its Millennium Development Goals in 2000, No. 5 on the list was reducing maternal deaths. Progress has been slow — with only four years left to go before the 2015 deadline, the maternal mortality ratio has declined by 34 per cent, less than half of the UN’s target.
Peter von Dadelszen meets with colleagues in Karachi, Pakistan (PHOTO BY DIANE SAWCHUCK)
One of the main obstacles is pre-eclampsia, the sudden onset of high blood pressure during pregnancy. It’s the second-leading cause of maternal death worldwide, resulting in 76,000 women dying a year — almost all of them in lower- and middle-income countries.
A woman can be spared the dangers of pre-eclampsia, which include seizures (eclampsia), stroke or failure of the lungs, kidneys or liver. It doesn’t take a lot of medical wizardry: She must be transported to hospital, where her blood pressure can be managed, her seizures prevented and her delivery induced, which ultimately is the only sure treatment.
But in much of the developing world, identifying women who are at-risk or already have pre-eclampsia — and getting them to a facility that can provide proper care — simply doesn’t happen.
“It really is a social equity issue,” says Peter von Dadelszen, [Professor] in the Department of Obstetrics and Gynecology. “If you really want to make an impact on maternal health, we must focus on countries where women routinely deliver their babies at home, or live far away from medical facilities.”
If Dr. von Dadelszen sounds like he has a plan, that’s because he does. And the Bill and Melinda Gates Foundation has signed on to it.
The foundation has given Dr. von Dadelszen and his team $7 million to test a battery of new strategies to monitor, prevent and treat pre-eclampsia. To increase the chances of its scalability, it will unfold in a broad number of countries in Africa (Mali, Nigeria, South Africa, Uganda and Zimbabwe), South Asia (Bangladesh, India and Pakistan), Asia-Oceania (China and Fiji) and Latin America (Brazil).
“We’re dealing with different cultures, different expectations, different barriers and different facilitators,” says Dr. von Dadelszen, Co-Director of the Reproduction & Healthy Pregnancy research cluster at the Child & Family Research Institute. “We have to be respectful of what the issues are in each place.”
One component of Dr. von Dadelszen’s project is a clinical trial in South Africa and Zimbabwe to test the efficacy of calcium supplements for women with low calcium intake and at high risk for pre-eclampsia in their next pregnancy.
Another component will test a method developed by Dr. von Dadelszen for diagnosing pre-eclampsia and assessing the degree of risk, based either on the woman’s symptoms, clinical examination and simple lab tests, or without any lab tests whatsoever.
The Gates grant will also fund the creation of “a treatment pipeline” that extends from remote villages to properly-equipped medical facilities in urban centres. Community health workers will be trained to use Dr. von Dadelszen’s diagnostic and risk-assessment tool, and to administer an anti-hypertensive drug (to prevent strokes), and magnesium sulfate (to prevent seizures). The pipeline will include a protocol for transporting women to hospitals that provide more elaborate care.
“Many women are moribund, or dead, by the time they are seen by someone who can help,” Dr. von Dadelszen says. “The idea is to reach into the community to make a difference.”
REPRINTED WITH PERMISSION FROM UBC MEDICINE, SPRING 2011, VOL. 7, NO. 1, Page 4-5
