Global Pre-Eclampsia Initiative (GPI) in partnership with St. Augustine International University (SAIU) – Kampala, Uganda) co-hosted the First World Preeclampsia Day (WPD) on 22 May 2017 to commemorate the first ever World Preeclampsia Day in Uganda.The event took place at the SAIU campus on Ggaba Road, Bunga Hill. It was honoured with the presence
of key stakeholders representing health care practitioners, researchers, the academia,
Information Technology (IT) sector and community mobilizers Non-Governmental
The WPD was observed in order to recognize the plight of Mothers and infants who have
suffered due to Preeclampsia. Preeclampsia is a disorder of pregnancy, typically occurring after
the 20th week of gestation, which, if not diagnosed early, usually results in a pre-mature
delivery and high mortality risk for both mother and child. Eclampsia means Lightening in Greek.
It is characterized by sudden and dangerous spikes in blood pressure, protein in the urine,
abnormal swelling of feet, face, and hands, upper abdominal pain, and nausea. The only known
treatment is to deliver the baby. Preeclampsia is the most common known cause of premature
birth and is responsible for half a million neonatal deaths every year worldwide.
BACKGROUND A 5th year Obstetric and Gynaecology Student, Abubakar Suleiman Tsamiya, brought about the topic of Pre-eclampsia to his Research Supervisors ayear ago;Suleiman put his effort to understanding and addressing the management of Mothers suffering from Hypertensive disorders, more specifically, Pre-Eclampsia/Eclampsia during pregnancy. After more research at Mubende Regional Referral Hospital during community placement, he went ahead and coinvented, within a team of Researchers and Students, a tool dubbed The P ETOGRAPH , an acronym meaning Pre- EclampticTOxaemia GRAPH (PETOGRAPH). The Petograph is an innovative and comprehensive monitoring tool for the integrated management of pre-eclampsia and eclampsia in low resource settings. In order to establish a platform to validate the viability of the Petograph, Suleiman set up a not for-profit organization called Global Pre-eclampsia Initiative (GPI), where he continues to further his and others’ understanding of Pre-eclampsia through workshops, social media, website, etc. GPI linked up with Preeclampsia Foundation in the United States of America (USA), an organization that has taken lead in lobbying the USA Congress to recognize the Preeclampsia
Day since the year 2000. It is from this partnership, that GPI got to learn about the World Preeclampsia Day and requested collaboration with SAIU to commemorate the 1st ever World Preeclampsia Day.
OBJECTIVES This is the first inclusive attempt at a global level to raise awareness of Preeclampsia. Globally, the purpose of this day was to raise awareness of preeclampsia and its global impact in a oneday worldwide event. This was done for the following reasons: 1. Increase awareness of preeclampsia as life-threatening complication of pregnancy, signs & symptoms, and long-term complications related to preeclampsia 2. Improve healthcare providers’ responsiveness to preeclampsia 3. Increase volume of traditional and social media coverage 4. Secure supporters for global call-to-action (i.e., proclamation) 5. Lay the groundwork for a possible United Nations (UN) or World Health Organization (WHO) proclamation for World Preeclampsia Day in future years.
At Uganda level, GPI and SAIU organized the WPD so as: 1. To recognize the plight of Mothers and infants who have suffered due to Preeclampsia. 2. To raise awareness and encourage self-health-seeking behavior among communities. 3. To encourage health professionals to gain more information and skills in dealing with preeclamptic mothers. 4. To urge decision makers to be more sensitive with the burden of the disease and create a policy environment conducive to its reduction. 5. To comprehend who is who in maternal and child health and create a think tank composed of key stakeholders for the overall preeclampsia course.
PARTICIPANTS The workshop was well attended, 23 out of the 28 invited participants honored the invitation. The participants invited were from the Academia, Researchers, Policy Makers, Public and Private sector – IT/ICT companies, NGO working on community mobilization and maternal and infant health, medical practitioners such as Obstetricians, etc. Key personalities who stood out in the area of Maternal Health and even more specifically Preeclampsia, included the
keynote speaker Dr. Annette Nakimuli, Head of the Obstetrics and Gynaecology Departments inMulago Referral Hospital, Kampala and Makerere University. To do her justice, this report will quote the East African Newspaper of February 13, 2016, to introduce Dr. Nakimuli; the paper described her as the Marie Curie of Uganda after she presented her findings at a conference organised by Makerere University where she led a team of medical researchers who declared their findings on the discovery of a set of genes found in African women that help fight a condition that kills many during pregnancy and childbirth – known as preeclampsia.
Dr. Nakimuli’skeynote presentation was extremely enlightening and disturbing, showing the work so far undertaken, and the enormous work, yet to be done in this area. Other distinguished professionals present included Prof. Florence Mirembe who facilitated group presentations. Prof. Mirembe teaches SAIU Students at Mulago Hospital and is formerly Dr. Nakimuli’s‘teacher.’
OUTCOMES The Preeclampsia Think Tank (PTT) was formed on this day of 22ndMay, 2017. It consistsof representatives from the Public and Private Health practitioners, researchers and academics, public and private sector, specialists in Information and Communication Technology (ICT) and community mobilizers (NGOs). The first discussions led to a clear conclusion: all stakeholders have a critical role to play (see Section 6: Follow-up plan)
Figure 3: Dr. Annette Nakimuli, HoD Obstetrics and Gynaecology; KhadijahBabirye, Community Cordinator, Mzima International
Figure 2: Right to left: Prof. Florence Mirembe, Specialist Obstetrics and Gynaecology, SAIU; Mr. Suleiman Tsamiya Principal Director GPI; Dr. Tiri Moses, Specialist Obstetrics and Gynaecology, IHK; Dr Matilda Okech, Microbiologist, SAIU.
The PTT agreed on the relevance of working under a GENERAL APPROACH that learns from THE PAST – Previous conception and management methods; analyzes THE PRESENT – The current burden and management strategies; and works for THE FUTURE – Researches and general improvement in the well-being of the mother and the baby.The presence of the authorities and policy makers was greatly missed and the organizers will double the efforts to reach out to them at the time of distribution of this report.
METHODOLOGY With an aim to constitute a Preeclampsia Think Tank (PTT), the invitations were deliberately tailored towards professionals and key stakeholders with expertise on health, especially Maternal and child health, more specifically, preeclampsia. After the formal introductions, agreement on the programme, and a word of welcome from the SAIU Deputy Vice Chancellor, Academic Affairs Prof. Yusuf Sadiq, participants keenly listened to the Keynote presentation. Dr. Nakimuli’s (Fig. 4) presentation was entitled: Pre-eclampsia in the busiest Maternity unit in Africa: The Mulago Hospital Experience . Here she revealed that Mulago Hospital is the busiest maternity hospital in Sub-Saharan Africa with 8% of admissions in the high risk labour ward being due to
pre-eclampsia (~4 daily). In 2016, Preeclampsia was leading with 21% (26 of them eclampsia and 3 other complications) totaling to 136 maternal deaths. Dr. Nakimulialso revealed that a new Women’s Hospital was in the making scheduled to officially open in July 2017. Currently, MulagoRefferal Hospital (on the left) is handling the preeclampsia cases at the national level with the major causes of Maternal Death at time of birth being Haemorrhage, Pre-eclampsia/eclampsia, Obstructed labour and Infections. The Preeclampsia burden, Dr.
Figure 5: Mulago Referral Hospital, Kampala, Uganda
Figure 4: Dr. Annette Nakimuli (the Marie Curie of Uganda)
Nakimuli added, complicates 6-8% of all pregnancies and is responsible for 10% – 40 % of maternal deaths in Africa yet its cause remains unclear and so difficult to prevent. The only definite cure currently, is delivery of the placenta/foetus.
CONTENT The group discussions generally evolved around the current status of Preeclampsia in Uganda; the causes and solutions of the major problems to which the burden of preeclampsia is attributed taking into account the scarcity of data and information available on known causes for Preeclampsia and eclampsia leading to maternal and child morbidity and mortality. Major issues discussed included: i) Scarce data and information. ii) Late diagnosis. iii) Poor referral system. iv) Unskilled and limited healthcare workers. v) Improper record keeping and data management. vi) Lack of patient follow-up on being
diagnosed with Preeclampsia. vii) Patients delay to seek help. viii) Lack of means of transport and poor infrastructure. ix) Lack of awareness. x) Delay in Treatment. Putting Uganda in the context, groups were requested to use their professional, practical and personal experiences to elaborate the causes associated with the above problems; they were also asked to discuss how these problems could best be addressed and by whom. In a bid to share responsibilities within the newly formed PTT, participants were asked how
the organizations they represented could best contribute to addressing these problems.
Figure 6: Detail of one of the groups recording their discussion
Figure 7: A view of the group discussions that took place at the upper floor of SAIU.
FOLLOW-UP ACTION PLAN This section presents the results of the second session of group discussions,where participants were grouped into various ‘homogeneous’ groups. There task was to discuss and suggest roles that they and their organizations could play in order to improve the current status of Preeclampsia in Uganda. i) The Academia: The group of Academics, which included Prof. Sadiq Yusuf the Deputy Vice Chancellor of SAIU for Academic Affairs, recommended Curriculum development and review i.e. developing Community health /guidelines; Organizing Continue Medical Education/Continue Professional Development (CME/CPD), in-service training and supervision for health workers; and encouraging collaboration among researchers in the areas of Preeclampsia. ii) Trainers, Researchers and Practitioners: Practitioners, researchers and trainers who included Dr. Annette Nakimuli and Prof. Florence Mirembe suggested robust research in Preeclampsia; Lobby for research funding; Create awareness raising; Provision of CDP; Pre-service and in-service training; Development of guidelines and protocols for management of Preeclampsia; Support for the supervision of lower health centers/ facilities; Mentoring lower health facilities(providers); Improvement of the mechanism of data collection in clinical settings; Lobby government to increase budget towards the heath care sector; Offering specialized care for the referred patients; and better management of Pre-eclampsia complications. iii) Private Sector IT/ICT Experts: This group Committed to increase Awareness/sensitization through Television (TV), Short Message Services (SMS), Electronic mail (email), Radio, Social media; developing tools for: data collection that enable, diagnosis- cheap digital Blood Pressure (BP); tracking mothers and doctors (follow up), reminders and notifications and effective fetal monitoring for prompt decision making. They also suggested forming ICT teams to provide support in hardware, software and human resource development. Working with police to set up Emergency system e.g. 911, free Unstructured Supplementary Service Data(USSD) dedicated to preeclampsia. iv) Civil Society Organisations (CSOs): CSOs pledged to advocate for better health services by government and other stakeholders and to raise mass awareness through community outreaches so as to change attitudes and behavior 9 through sensitization on preeclampsia. They will urge the government to prioritize the health sector in resource allocation especially towards Maternal Health, specifically preeclampsia. They will educate the elders and community leaders on preeclampsia by working with social and cultural institutions. They will investigate ways in which mothers can access micro health insurance. v) Other outstanding issues during the discussion on way forward included: a) To make more effort to work within other existing networks and platforms working on Maternal and Child Health so as to consolidate efforts and avoid duplication. b) To find a more suitable and easy to pronounce name for preeclampsia so as to make it easy to understand, especially at the community level. c) To come up with a more actionable work-plan including financial support for the PTT to ensure efforts continue after the WPD. d) To address myths and misconceptions about preeclampsia within communitiesin order to encourage early detection and health seeking behavior.