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International obstetric practice has been changed by two large randomised controlled trials led from the University of Oxford's National Perinatal Epidemiology Unit, which demonstrated the efficacy of magnesium sulphate for both treatment and prevention of eclampsia during pregnancy, a condition characterised by fits in association with hypertension, and an important cause of maternal morbidity and mortality. Until the 1990s there was widespread geographical variation in the management of the condition, with magnesium sulphate used almost exclusively in North America. Following the publication of the results of these two trials magnesium sulphate is now in routine use globally, widely recommended in guidelines, and has been placed on the WHO Model List of Essential Medicines.
Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries with young children and pregnant women particularly at risk. Over the last 20+ years LSHTM researchers have carried out a series of definitive trials in collaboration with the Ghana Health Service to evaluate the impact of different vitamin A supplementation (VAS) strategies on maternal and/or child survival. Findings have had major impacts on national and global VAS programmes and influenced WHO guidelines on VAS in: infants and children 6-59 months of age; infants 1-5 months of age; postpartum women; and pregnant women.
Research by Dr Garikipati identifies that microfinance is most beneficial to women when it enables them to enhance their livelihoods and participate in the local enterprise economy. It also shows that over 80% of the microfinance loans in Andhra Pradesh, India, did not meet these conditions. Using these research findings, Dr Garikipati directly lobbied the Government of Andhra Pradesh (GoAP). This has had an impact on governmental organisations and other stakeholders within the microfinance industry and lead to the introduction of the Livelihood Enhancement Plan (LEP), which is used at the time of loan application. Dr Garikipati collaborated with the GoAP in designing and implementing the LEP. It impacts 500,000 women per year who join the microfinance program and enables them to enhance livelihoods in keeping with the demands of the local economy.
The findings of empirical research conducted by Professor Jim Barry and Dr Trudie Honour of UEL were shared at two focused capacity building sessions held in 2008 and 2009 for women leaders in middle and senior positions of responsibility and decision-making in the public and third sectors of a number of developing countries. Workshops were attended by women from Albania, Bahrain, Brazil, Burma, Cambodia, Cameroon, Ecuador, Egypt, Ethiopia, Jordan, Kenya, Malaysia, Mexico, Oman, Pakistan, Philippines, Tunisia, Turkey, and Uzbekistan. Participants considered the relevance and application of the research findings for their own countries, and worked together and with the researchers to formulate potential capacity development implementation strategies for women in positions of responsibility in those countries.
Instrumental births can cause problems and are needed more often with epidurals. The Comparative Obstetric Mobile Epidural Trial (COMET) was the definitive trial that led to the NICE Intrapartum Care guideline recommendation to discontinue traditional epidurals using high concentration local anaesthetic solutions in favour of low dose epidural techniques which allow women to be mobile during labour. It is estimated that these changes have resulted in about 10,000 fewer instrumental deliveries annually in the UK. Correspondingly, numbers of women experiencing effects of instrumental births such as faecal incontinence will have been substantially reduced. This research has also influenced clinical guidelines and led to changes in practice on the type of epidurals used during labour elsewhere, including Australia and Canada.
Impact: Health and welfare; public policy; the work led to UK and international guidelines advising against progesterone use to prevent preterm birth in twin pregnancy.
Significance: Thousands of women now avoid this unpleasant procedure annually, with a saving to the NHS of £25M.
Beneficiaries: Pregnant women, policy-makers, the NHS and healthcare-providers.
Attribution: The work was initiated by a five-centre UK collaborative group including UoE. Data analysis, interpretation and translation into practice were led by Jane Norman, UoE.
Reach: The data are cited in guidelines and have changed clinical practice on three continents: Europe (NICE), North America and Australasia. Applies to 11,000 women annually in UK alone.
56% of the European Union (EU) population and 35% of the population of Northern Ireland (NI) live in rural areas. While rural living is sometimes portrayed as an idyllic lifestyle, the reality often differs. Lower population density means that services are more limited than in urban areas, with different impacts for particular socio-economic groups, especially women. For example, lack of childcare provision can affect rural women's ability to work outside the home. The gendered nature of farm ownership means that farming policies have not always addressed farming women's needs. The research in this case study had the following impacts:
Impact: Health and welfare; healthcare guidelines on elective induction of labour. The research showed that elective induction at time points from 37 weeks' gestation progressively reduces perinatal mortality. UK guidelines now recommend routine induction at 39 weeks in mothers >40 years of age.
Significance: Implementation of the guidelines for mothers >40 years of age is estimated to prevent the stillbirth of 17 babies per year in the UK.
Beneficiaries: Pregnant women, policy makers and healthcare providers.
Attribution: The work was led by Jane Norman with Sarah Stock at UoE, in collaboration with NHS Information Scotland.
Reach: UK, Europe, North America. Applies to all pregnant women, especially those over 40 years of age.
Pre-eclampsia is a major contributor to death and disability in pregnancy. Diagnosis, based on accurate blood pressure (BP)/proteinuria determination, is limited by measurement errors and being late features of the disease. In collaboration with industry, King's College London (KCL) researchers have developed an inexpensive, accurate, simple BP device suitable for rural clinics. This device allows intervention to reduce mortality/morbidity and is currently being rolled out in a Gates Foundation project in Africa and Asia. KCL researchers have also helped the company Alere Inc. with the development of a diagnostically accurate test of placental growth factor (PlGF) in women with suspected pre-eclampsia: Alere Triage®PlGF. This demonstrates high sensitivity, superior to current tests, and following commercialisation is being adopted internationally. Their work is additionally reflected in guidelines of international standards for BP device accuracy.
Maternal health and mortality remains a major concern in the developing world. Research led by Prof Arri Coomarasamy and colleagues at the University of Birmingham has demonstrated the effectiveness of non-typical support for maternal health in low- and middle-income countries worldwide, focused on the benefits of bringing in traditional birth attendants and non-physician clinicians to support the slow process of developing more capacity amongst skilled birth attendants in these regions. Prior to this work, these individuals were considered unsafe and inappropriate to support births, even though they were conducting millions of deliveries in the developing world. Prof Coomarasamy's team's research clearly demonstrated that this is not the case. This has had a major impact on international thinking about the valuable role of non-physician support for maternal health and mortality, reflected in the latest World Health Organisation task-shifting recommendations. In these and other related issues, policy and public awareness has been further supported by Prof Coomarasamy's crucial role in Ammalife, an international maternal health charity focused on the developing world.