Calcium aspirin preeclampsia early prevention and response (CASPER)
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Date
2020-10-16
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Kamuzu University of Health Sciences
Abstract
Globally, preeclampsia/ eclampsia remains the third leading cause of maternal mortality. In
developing countries, the burden of preeclampsia/eclampsia is worsened by lack of preventive
interventions which have been identified to be sophisticated, expensive but effective in early detection
of its risk. As a result, there is still more gaps in what could be feasibly work for developing countries.
Currently Malawi has not been spared out to this high incidence of preeclampsia/ eclampsia which
has highly affected perinatal outcomes and contributed more to an increase in maternal mortality
ratio. Despite WHO recommending administration of low dose aspirin or calcium as a preventive
measure, literature has not been found regarding its use in the Malawian hospital set up.
Problem: There are still some gaps in knowledge as what could be the barrier to early pregnancy
this intervention and also the feasibility and effectiveness of low dose aspirin given together with
calcium in preventing preeclampsia/ eclampsia in Malawian setting. The barrier to early pregnancy
intervention in preventing risk of preeclampsia especially use of calcium and aspirin in Malawi not
yet known.
Main objectives: To assess the barriers to early pregnancy intervention and the
effectiveness of low dose of aspirin and calcium in preventing risk of preeclampsia especially use of
calcium and aspirin in Blantyre, Malawi.
Specific objectives: Specifically, the ,the study aims at exploring barriers to early pregnancy intervention in preventing preeclampsia/eclampsia among health workers, patients and policy makers in Blantyre, Malawi, assessing knowledge and of health workers and policy on preeclampsia, preventive measures especially use of calcium and low dose aspirin at QECH, Blantyre will assess health worker/ policy makers
barriers to providing early pregnancy intervention to prevent preeclampsia/eclampsia to high risk
pregnant women especially; the use of calcium and low dose aspirin at QECH , Blantyre Malawi.
It will also investigate patient’s barriers to accessing early pregnancy intervention to prevent
preeclampsia/eclampsia among women who had suffered from preeclampsia/ eclampsia at QECH
Blantyre, Malawi. The study will further investigate the knowledge and perception of patients
towards preeclampsia/ eclampsia and also assess the knowledge of health workers and policy
makers on the use of calcium and low dose aspirin as a preventive measure of
preeclampsia/eclampsia at QECH, Blantyre. Not only that, Phase two will mainly focus on
assessing the effectiveness of early low dose of aspirin and calcium in preventing pre-eclampsia and eclampsia in Blantyre, Malawi and identifying challenges of early use of low dose aspirin and
calcium in high risk pregnant women in Blantyre, Malawi.
Methodology:
Design: We will conduct descriptive cross sectional study using qualitative analysis and double
blinded randomized controlled clinical trial using quantitative analysis. The study will be split in two
phases, phase 1 will be conducted at Queen Elizabeth Central Hospital(QECH) and phase 2 will be
conducted at four urban health centers in Blantyre as well as Queen Elizabeth Central
Hospital(QECH) as a referral center.
Data collection: Qualitative data will be collected using IDIs and SSQ while quantitative data will
be collected using questionnaire.
Data analysis: Thematic content analysis will be used to analyze and interpret the qualitative data
and quantitative data descriptive and inferential statistics will be analyzed using Stata software.
Ethical consideration: Approval from the, College of Medicine Research and Ethics committee,
Blantyre District Health Office (DHO), QECH and Pharmacy and Poisons Board of Malawi will be
sought and reciprocal approval from Western Sydney University. Informed consent will be sought
from all study participants. Confidentiality and privacy will be maintained throughout the study. Only
investigators of the project and independent project officer (involved in data collection) and
statistician will have access to the data.
Expected findings: We expect to obtain a different in outcome in the incidence of preeclampsia and
eclampsia in Blantyre district. We also expect variations in knowledge of preeclampsia across the
interviewed group. We also expect to identify what challenges that may arise in using aspirin and
calcium as a preventive measure.
Dissemination of findings: A report will be written and submitted to Western Sydney University in
the form of a PhD thesis. Presentations at college conferences at Western Sydney, Australia, College
of Medicine research disseminations and COMREC in Malawi and at the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2020, 2021 and 2022 will be planned. Results
will be published in peer reviewed journals. In addition the findings will also be shared with
BTDHO as well QECH.