Maternal, Newborn and Child Health
The World Health Organisation estimates that 800 women die every day due to complications in pregnancy or childbirth, 99% of these deaths occurring in low-income countries. The most common causes of maternal mortality are obstetric haemorrhage, sepsis and pregnancy associated hypertension. Between 1990 and 2015, following a commitment by the international community to reduce maternal mortality, the number of deaths worldwide dropped by about 44%. This led to countries uniting behind a new target to reduce the global maternal mortality ratio even further, to less than 70 per 100 000 live births between 2016 and 2030. While child (under five) mortality has more than halved since 1990, neonatal deaths (in the first 28 days) have been slower to fall, and now account for nearly half of all child deaths.
The Women’s Global Health Group (part of the KHP Women’s Health Academic Centre) leads on Global Maternal, Newborn and Child Health at King’s, from strengthening healthcare systems to developing inexpensive, life-saving, technologies within widespread implementation programmes. The aim is to improve care and its outcomes in low and middle income countries
Work in Burkina Faso and Zambia has focused on the long-term impacts of obstetric near-misses, and the safety of abortions and post-abortion care. In Brazil, the Women’s Global Health Group leads research into maternal nutrition and health in Rio de Janeiro, and partners with FIOCRUZ on the PrePARE project, funded by the Bill & Melinda Gates Foundation. PrePARE aims to reduce unnecessary premature delivery by training staff to use WHO guidelines for preventing preeclampsia, and trialling a method for identifying low-risk women whose pregnancies can be safely prolonged. The study generates data and biological samples that can be used to help better stratify risk and understand the disease.
The King’s CRADLE team has developed a simple ‘Vital Signs Alert’ (VSA) device that measures blood pressure and pulse and calculates the risk of preeclampsia and shock. Results are displayed on a traffic light, alerting health care providers to those at risk. The CRADLE VSA has been developed to meet WHO criteria for use in a low resource setting, being accurate, low cost, robust and portable. The CRADLE team is now conducting a large trial of the potential for this device to reduce maternal mortality funded by the Bill & Melinda Gates Foundation, UK Department for International Development and Medical Research Council/ Department of Biotechnology. The CRADLE team work with partners in Zambia, Uganda, Ethiopia, Sierra Leone, Haiti, Ethiopia, India, South Africa, Mozambique, Pakistan, and Nigeria.
The potential for health system strengthening to improve the processes and outcomes of maternal care will be explored by the ASSET NIHR Global Health Research Unit in Ethiopia and South Africa. This will include work on care pathways, the introduction of the CRADLE VSA, and integrated interventions for the detection and management of violence against women and antenatal depression.
PRECISE is a capacity-building partnership of 10 universities led by King’s College London, investigating novel methods for diagnosis and management of placental disorders (linked to pregnancy-associated hypertension, inter-uterine growth restriction and stillbirth) in Gambia, Kenya, Mozambique and Zimbabwe. PRECISE will establish a pregnancy cohort of 12,000 women, collecting biological samples and information about patients’ lives, contexts and stories. An interdisciplinary and holistic approach to advance understanding of these complex issues will inform better and earlier detection, diagnosis and management of placental disorders across sub-Saharan Africa.
Women’s mental health research at King’s is well integrated into work on maternal care pathways, including studies of trafficking and violence against women, in the UK and Europe, and epidemiological studies of perinatal depression and its impact on obstetric, neonatal and child outcomes in Ethiopia and Ghana. Further examples of KGHI led work on child development include research into the nutritional regulation of 'healthy' fetal and infant growth and development in the Gambia, and a pilot trial of parent skill interventions for the management of developmental disorders in rural Ethiopia.