08 Mar 2024
IWD: inaugural inter-institute Global Health Seminar shines a light on maternal and newborn health
As the globe joins hands to commemorate International Women’s Day (IWD) today, we reflect on the presentations and deliberations at the first of its kind quarterly inter-institute Global Health Seminar Series hosted at the Burnet Institute this week, which focused on maternal and newborn health. The seminar was co-organised by the Doherty Institute, Burnet Institute, Melbourne Children’s Global Health and the Nossal Institute for Global Health.
Safe Delivery App in Papua New Guinea (PNG)
Presented by Dr Delly Babona, Research Officer at the Burnet Institute
In 2012, a Safe Delivery App (SDA) was rolled out by the Maternity Foundation in partnership with European universities and is currently in use by 400,000 users across 70 countries. The SDA is an innovative tool currently used by healthcare workers to access evidence-based, up-to-date clinical guidelines for maternal and newborn care. The 16 modules in the application cover extensive emergency obstetrics and newborn care using animated videos, action cards, practical procedures, drug lists and a learning platform.
In her presentation, Dr Babona focused on the use of the SDA in PNG, a context where maternal mortality is one of the highest in the world, with as many as 585 women out of 100,000 dying during childbirth. This figure is 35 times higher than in Australia and 270 per cent more than the global ratio.
Researchers at the Burnet Institute focused on adapting the application content for PNG and reviewing its usability. Introduced in 2020, the PNG SDA version has 1,300 users, of whom more than 50 per cent are midwives. These healthcare workers have been highly engaged with modules on managing labour, hypertension and normal deliveries.
The researchers received positive testimonials from users who often work without doctors. The application gave healthcare workers the opportunity to update existing knowledge and skills and to deal with complications with guidance and confidence.
“With this project, we hope to go one step further with the App. By adapting the SDA to the PNG context and rolling it out to our rural health workforce, we hope that this will be the experience for all healthcare workers out there,” concluded Dr Babona.
TB and Pregnancy: building consensus on inclusion in research
Presented by Alison Abboud, Clinical Research Project Coordinator at the Doherty Institute
Tuberculosis (TB) remains the fifth cause of maternal illness in countries where it is prevalent and is associated with an increased risk of preterm birth, low birth weight and neonatal death. The exclusion of pregnant and breastfeeding women in therapeutic and vaccine research stems from a desire to avoid foetal risk. This is despite the higher likelihood of pregnant and postpartum women to develop TB compared to their non-pregnant counterparts.
In her presentation, Ms Abboud argued that excluding pregnant women in research does not remove risk, but instead shifts it from controlled research settings onto the pregnant woman and her clinician. She argued that the research community’s convenient choice of excluding pregnant and often breastfeeding women from research altogether needs to change.
“We must shift this mindset from one of protecting pregnant women from research to protecting them through research,” said Ms Abboud.
In 2023, the SMART4TB Consortium, the IMPAACT Network and the WHO Global Tuberculosis Programme convened to launch a consensus process on the optimal timing and design of studies to improve TB treatment and prevention options for pregnant and breastfeeding women. They identified urgent evidence gaps for future research in pregnant women, including TB surveillance, diagnosis, prevention and treatment.
Ms Abboud is committed to contributing to this research through inquiries into TB infection in pregnancy and antenatal screening of the disease, among other research works.
Optimising the participation of pregnant women in clinical trials
Presented by Dr Mridula Shankar and Ms Alya Hazfiarini, Nossal Institute for Global Health
Closely related to TB and pregnancy, Dr Shankar and Ms Hazfiarini explained how the continued underrepresentation of pregnant women in clinical trials, because of concerns over foetal harm, is limiting the development of diagnostic and novel therapeutics for this demographic.
They identified four roadblocks to the participation of women:
- Indoctrination of pregnant women as vulnerable
- Knowledge gaps due to gender-biased research
- The double disadvantage for women in the ‘Global South’
- The undervaluation of pregnant women’s perspectives
Primarily qualitative studies from 27 countries, with more than 50 per cent representation from pregnant and lactating women, found several facilitators and barriers to engaging this cohort in clinical trials. In most instances, making trade-offs between risk and severity of a condition remains problematic. Issues of trust and power in the medical research ecosystem, bodily autonomy and challenges with ethical approvals for trials with pregnant women are significant hurdles. Ongoing research in low- and middle-income countries is examining the perspectives of pregnant women, family and community members, healthcare providers, administrators,and ethics committee members regarding pregnant women’s participation in clinical trials.
To eliminate harmful gender bias affecting maternal health, the presenters stressed the importance of prioritising multi-disciplinary research focussed on the safe participation of pregnant women in all stages of biomedical research. Ethics committees also need to rethink their approach by placing a greater emphasis on responsible inclusion rather than defaulting to presumptive exclusion.
Management of hypoxaemia in small and sick newborns
Presented by Dr Shiraz Badurdeen, Neonatologist and Melbourne Children’s Global Health Postdoctoral Fellow
Hypoxaemia, a life-threatening condition of low blood oxygen levels associated with many illnesses, including pneumonia, malaria and complications from preterm birth, is prevalent in newborns. More than a third of neonatal deaths are caused by preterm birth complications and a further 25 per cent by labour and childbirth complications. Managing this condition comes with considerable risks and is crucial in saving the lives of newborns.
Referencing a study conducted in Nigeria, Dr Badurdeen said that hypoxaemia substantially increases the risk of mortality, advocating for the essential inclusion of oxygen monitoring in clinical care. Initiatives have been taken to address hypoxaemia by expanding access to medical oxygen and improving screening for hypoxaemia, especially in countries with the highest paediatric pneumonia mortality rates. However, a comparison study in Nigeria observed no improvement in children mortality rates and suggested a possible increase in the risk of neonatal death following the introduction of a multifaceted oxygen system.
“Oxygen is an essential medicine but it must be delivered safely,” said Dr Badurdeen.
For babies born prematurely, due diligence is essential when using oxygen therapy due to their unique physiological vulnerabilities. While it is lifesaving, this treatment comes with several potential risks and complications, including blindness and injuries to the lung and brain associated with resuscitation.
Ensuring the safety of oxygen administration for newborns requires a whole systems approach, one that includes affordable, accessible and easily maintained equipment. The appropriate use of devices for measuring oxygen saturation levels in the blood is also critical in reducing neonatal deaths.