Addis Ababa University (AAU)-Emory University Academic Health Center Partnership Program Yirgu G. Hiwot, M.D. Professor of Obstetrics and Gynecology Faculty of Medicine, AAU Henry M. Blumberg, M.D. Professor of Medicine and Epidemiology Division of Infectious Diseases Emory University School of Medicine High Maternal Mortality in Ethiopia • Maternal Mortality Ratio in Ethiopia: 590 per 100,000 live births • Ethiopia is one of 6 countries that accounts for >50% of all global maternal deaths (Hogan MC. Lancet 2010) • Pre-eclampsia /Eclampsia is the leading cause of maternal mortality in Addis Ababa and one of the top 5 causes in Ethiopia • No availability of magnesium sulfate in Ethiopia (drug of choice for treatment for pre-eclampisa/eclampsia) MgSO4 on WHO List of Essential Medications and inexpensive AAU-Emory Collaboration Improving Maternal Health • Pre-eclampsia and eclampsia: hypertensive disorders of pregnancy Pre-eclampsia: elevated blood pressure plus proteinuria Eclampsia: seizures + pre-eclampsia Complications: stroke, renal failure, ARDS, DIC, death; also contributes to neonatal morbidity/mortality AAU-Emory Collaboration Improving Maternal Health • Substantial data that MgSO4 is drug of choice for pre-eclampsia and eclampsia • Compared to diazepam (Valium), MgSO4 is associated with Reduction in maternal death (59%) Reduction in progression from pre-eclampsia to eclampsia Reduction in risk of recurrence of further seizures (44%) MAGPIE Trial Lancet 2002; Cochrane Database Syst Rev 2003 AAU-Emory Partnership Improving Maternal Health/MDG 5 • Project Proposed by AAU faculty; Consensus on Project for UM/Gates Pilot Grant: Implementation of the use of MgSO4 for the treatment of pre-eclampsia /eclampsia at 3 AAU Teaching Hospitals 1000 deliveries per month at these hospitals (8-10% estimated to have pre-eclampsia/eclcampsia) Enthusiasm at MOH and others • Currently no availability and no use of MgSO4 for the treatment of pre-eclampisa/eclampsia in Ethiopia; diazepam has been used Science 2007; 318:1728 Nature 2008;453:840 AAU-Emory Collaboration Improving Maternal Health Specific Aims 1. Conduct a KAP survey of health care providers at the 3 AAU teaching hospitals prior to (baseline) and after implementation of MgSO4 2. Implement the use of MgSO4 for the treatment of pre-eclampsia/eclampsia at 3 AAU teaching hospitals 3. Determine the proportion of patients who appropriately receive MgSO4 and assess outcomes compared to baseline period before availability of MgSO4  Reduction in progression to eclampsia (seizures)  Impact on maternal morbidity and mortality  Impact on neonatal outcomes Progress/Timeline Activity Comment Date (2010) Protocol Development MAGPIE [Lancet 2002], Pritchard [1984] Feb-March KAP Survey development Developed by AAUEmory partnership; no validated survey existed Feb-March KAP Administration 20 OB/GYN faculty, 70 OB/GYN housestaff, 80 medical students; nursing staff on OB Developed surveillance system for pre-clampsia/ eclampsia REDCap Late AprilMay (evidenced based) Data Collection Form Database construction Feb-March Feb-March Progress/Timeline II Activity Comment Date (2010) Educational materials -Pocket Card for HCWs April, Educational Interventions Procurement -Poster for L&D with MgSO4 protocol -Use of MgSO4 protocol -ESOG (Ethiopian Society of OB/GYN) collaboration -Dr. Yirgu (AAU), Mark Adelman (Emory MS4) invited to talk at ESOG -Training of OB Chief Residents MgSO4 (?UNICEF) Calcium Gluconate ongoing May-June May 1 Conf Pending Dashboard: Impact of AHC Partnerships 1. How does an African medical school influence public policy, impact health programs? • Implementation of MgSO4 by 3 AAU teaching hospitals can serve as pilot/model for subsequent scale up/role out of MgSO4 use at 115 hospitals in Ethiopia (UNICEF, MOH, ESOG) • Development of protocol, educational materials leveraged for country-wide use in collaboration with UNICEF, MOH, ESOG • Overcoming procurement and other challenges: through public-private partnership (UNICEF, MOH, ESOG, AAU-Emory AHC partnership) Dashboard: Impact of AHC Partnerships 2. To what extent is the African medical school generating new knowledge relevant to health systems through evaluation, research, and development of research capacity? Science 2007; 318:1728 • Research to optimize scientific advances and facilitate their adoption in the real world Other Activities and Benefits • Infectious Diseases (ID) Training Program Collaboration supporting new AAU/Black Lion ID fellowship • AAU, Emory, McGill Johns Hopkins • Teaching on Internal Medicine and ID services Emory Team at AAU in in March 2010 Collaborative ID fellow (AAU-Emory) research North America visit /Black Li • KAP—Cervical Cancer/ Screening • Emergency Medicine collaboration (May 2010) Tikur Anbessa (Black Lion) Hospital • Other Departments Emergency Dept Acknowledgements • Miliard Derbew, M.D. (Dean, Faculty of Medicine, AAU) • Sara Haile, MPH (Coordinator, International Activities, AAU) • Jeffrey Koplan, MD, MPH (Emory Global Health Institute) • Mark Adelman (Emory 4th year medical student) • Jennifer Goedken, MD (Emory OB/GYN Dept)