Category: Maternal and child health

How can we safely and effectively dose medicines for children with obesity?

The legs of an overweight child standing on a set of digital scales.

By Alex, Nick, Jonny and Calandra, IGHI’s Helix Centre.

The number of children with obesity has risen rapidly over the past 40 years.

According to data from the World Health Organization the number of overweight children increased 8-fold between 1975 and 2016, from 1% of children to 6% of girls and 8% of boys. In 2013 there were 42 million under-fives worldwide who were overweight or obese. And over a quarter of 2-15 year olds in England are estimated to be overweight or obese today. This poses a significant challenge to the safe and effective dosing of medications for children. (more…)

On entrepreneurship and seizing opportunities to make healthcare safer

A photo of Ana talking on stage

By Ana Luisa Neves, co-founder of momoby, GP and IGHI Research Fellow. 

At momoby, we believe every woman should have access to prenatal care, regardless of where she lives. To tackle this challenge, we’re developing a low cost, pocket-sized device that tests for diseases that could harm pregnancy, using a single drop of blood. (more…)

Towards safer and more equitable maternal health care

by Ana Luisa Neves, General Practitioner and Research Associate at Imperial NIHR PSTRC

Making motherhood safe is a human rights imperative. In the last 20 years, a steady decline has been observed in maternal mortality rates worldwide, but much more needs to be done: nearly 300,000 women still die every year because of pregnancy or childbirth-related complications (1). This means that a mother dies every two minutes.

(more…)

Supporting midwives in The Gambia to save the lives of mothers and children

5 May 2017 marked the International Day of the Midwife. Recognising the important role that midwives play to families and mothers, the day was first established in 1992. Midwives endure rigorous training to ensure that they can provide quality care for those in need. The level of skills amongst midwives however, can vary across the world.

March 2017 saw the arrival of Dr Beverly Donaldson, her midwifery colleagues Maggie Welch and Judith Robbins and paediatrician Dr Anna Battersby from Imperial College London/Imperial NHS Trust to facilitate the third midwifery training programme at the MRC Fajara The Gambia. The aim of the training was to support local midwives in their clinical practice by teaching them the necessary skills to manage basic obstetric emergencies in order to save the lives of mothers and babies in their care. Together, they give their account of the event.

“It was a busy few days following our arrival; preparing all the equipment and teaching materials over the weekend in readiness for the start of the intensive two day training programme on the Monday morning.

Midwives attended practical emergency skills training in the management of Eclampsia, Postpartum Haemorrhage and blood loss estimation.

The first day began with lectures in maternal and neonatal mortality and the management of high risk pregnancy in The Gambia. The afternoon was dedicated to practical emergency skills training in the management of Eclampsia, Postpartum Haemorrhage and blood loss estimation – the major causes of maternal mortality. Running concurrently to the skills stations was a question and answer session in the library which gave participants the opportunity to openly discuss concerns related to maternal and neonatal care.

The second day focused on helping babies breathe

The second day focused on neonatal wellbeing and ‘Helping Babies Breathe’- an evidence-based educational program to teach neonatal resuscitation techniques in resource-limited countries- an initiative of the American Academy of Pediatrics (AAP) in collaboration with the World Health Organization (WHO). Anna and the team had previously adapted these materials to meet the needs of the Gambian staff and shortened it to make it more accessible to more midwives. We found this to be a simple and effective teaching method which was well received by the lovely midwives in the picture.

Following the formal training sessions, we then visited three participating maternity facilities to evaluate the effectiveness of the training by meeting with the lead midwife from each establishment and then assessing their ability to lead the teaching in their own unit. Consequently, we met with very enthusiastic midwives who were very happy to share the knowledge and skills they had been taught.

It quickly became evident that the midwives were very good at leading the teaching but they lacked the necessary equipment to continue training at their respective units. After discussion with our training faculty it was decided that we would donate the training mannequins with a view to replacing them before we facilitate the next programme.
Overall the training was very successful, was well evaluated and received very positive feedback from  the midwives who attended”.

The training was organised and facilitated by Dr Beverly Donaldson with Dr Anna Battersby and the Centre of International Child Health (CICH) at Imperial, led by Prof Beate Kampmann, who also regularly works at the MRC Unit. Prof Kampmann stated: “I am very pleased that the CICH can support this training effort, as it is an excellent example of our vision to involve a multi-disciplinary group of health care professionals and advocates in our work to improve maternal and child health. Midwives worldwide play such an important role in achieving this goal and I thank the imperial team for their efforts and dedication.”

Mums step up to make vaccines work at all ages – even before their babies are born!

By Dr Beth Holder and Professor Beate Kampmann Paediatrics, Centre for International Child Health, Imperial College London

The great success of vaccination during pregnancy

MatImmsPregnancy. For millions of women and their partners, discovering that they are expecting a baby is a very exciting time. However, it can also be a quite stressful time; suddenly there are lots of things to think about. There’s the fun stuff – wondering whether you are having a boy or a girl, thinking about baby names and buying first items of tiny baby clothes. Then there’s the more serious stuff- thinking about a birth plan, and suddenly having to attend several doctor and hospital appointments. One other thing for expectant parents to think about is whether they get vaccinated against specific infections whilst pregnant – this is called maternal immunisation.

This week, we celebrate European Immunisation week with the slogan of “Vaccines work- at all ages”. Pregnant women are a group that might not be on everyone’s radar for vaccinations, which we usually associate with children, right? However, maternal immunisation is a really clever way of enhancing what mother nature already does anyway: passing protective antibody from the mum to her unborn baby across the placenta. Therefore, giving certain vaccines in pregnancy will boost protective antibody in both mum and baby, therefore not only protecting the mothers from the infection, but their child in their first weeks of life.

Maternal immunisation has been a huge success story – initially in countries in the world where a lot of babies used to die from tetanus infection – and now also in Europe. The two most widely used vaccines in pregnant women in Europe protect against influenza (flu) and pertussis (whooping cough). The whooping cough vaccine was introduced in several countries following large-scale outbreaks of the disease. Whooping cough is extremely serious in young infants, and in the UK alone it caused the deaths of 27 babies between 2012 and 2015. The response by public health authorities was decisive; vaccinating mums could help protect these vulnerable children. Following the rollout of maternal pertussis vaccination, large studies have shown that it is safe, and extremely effective at preventing whooping cough in young infants.

But we still have some way to go. Studies in the UK show that despite overall maternal vaccination coverage continuing to rise, it’s still only reaching an average of 60% of the women who should have it. As part of our research at Imperial College London, funded by the NIHR Imperial BRC, we have held detailed interviews with pregnant women to seek their opinions on maternal immunisation and to find out why some chose to decline vaccination whilst pregnant. Their views were diverse, but one key thing we realised that we as researchers could address, was their desire for more information. As a result, we designed an app to fill this need- MatImms.

Developed by a team of scientists, clinicians and midwives, the MatImms app provides reliable information to expectant parents. It includes information about the immune system and how vaccines work, written in a clear and understandable way. It also provides detailed information on the current vaccines available to pregnant women, including how and when women can receive these vaccines. Finally, the app has a personalisable vaccination calendar, based on the woman’s due date, which provides reminders. Currently focused on the UK setting, we hope in the future to extend the app to include country-specific information to cover the rest of Europe.

In line with this year’s motto for European Immunisation week, we know that vaccines in pregnancy work and many mums are already stepping up to help protect their unborn babies from life-threatening infections; now we want to make sure that our research helps and supports as many mums as possible in this decision.

The MatImms app is freely available for iPhones and Android in iTunes and Google Play.

Life after miscarriage – one year on

By guest blogger, Alex, from That Butterfly Effect to mark Pregnancy and Infant Loss Remembrance Day on Saturday 15th October 

The 6th October marked a rather sad day for me and for my little family. On this day in 2015, I was admitted to hospital for a procedure called ERPC which stands for Evacuation of Retained Products of Conception and means a surgical removal of the remains of a pregnancy. It was a day that I had never thought I would ever have to experience and yet it happened to us. Just as it happens to more than one in five pregnancies in the UK every year – around a quarter of a million each year…

This second pregnancy started off wonderfully well, just as the first one. A bit of nausea, very sore breasts and some fatigue experienced during the day but overall, I felt really great. This carried on for a few weeks and then, suddenly, all the symptoms stopped, around week six or seven. I found the sudden disappearance of the soreness of breasts particularly worrying – I just had this feeling in my gut that this was way too early for them to stop hurting. And so what I did next was what we’re always told not to do – I googled the symptoms. There were quite a few forums with similar topic threads and the women discussed that dreaded M-word. Miscarriage.

Missed miscarriage (when the baby stops growing inside you but isn’t expelled from your body) was mentioned there and some things just clicked in my head. “This is exactly what has happened to me.” So I confided in my husband. He was concerned about me worrying and looked into miscarriage, but from a more pragmatic point of view, looking into ‘scientific’ evidence behind a sudden loss of pregnancy symptoms. There was nothing there to suggest a miscarriage could be easily ‘diagnosed’ simply by the loss of symptoms – there are just too many factors caused by hormonal changes happening in all stages of pregnancy. In my heart though, I just knew something was not ‘right’. The rational and optimistic part of me wanted to listen to my husband and the midwife who at the booking appointment told me not to worry as “everything will be fine”. Luckily, our dating scan was booked at 10 weeks rather than at 12 weeks so I couldn’t wait to have my mind put at rest. Going to friends’ wedding two days before the scan was not a pleasant experience – worrying about the worst case scenario whilst trying to put on a happy face and avoiding friends’ offers for a drink was so hard. They just knew I was pregnant and everyone started congratulating us. What do you say to that other than ‘thank you’? I felt emotionally drained from the past few weeks’ rollercoaster of thoughts and emotions – stuck between two sides of me, one telling me “you’re over-analysing it, just calm the f* down” and the other one crying hysterically “why do bad things always happen to good people?” before actually being told the worst. The days leading up to the scan couldn’t have dragged on for longer. (more…)

FEAST – five years on

By Professor Kathryn Maitland, Director of the IGHI Centre of African Research and Engagement. 

First published by the Hippocratic Post on 22/8/16.

kath 3
Professor Kathryn Maitland

‘Back in 2011, my research team published the results of the largest trial of critically ill children ever undertaken in Africa (FEAST trial), a trial that examined fluid resuscitation strategies in children with severe febrile illnesses (including malaria and bacterial sepsis). Contrary to expectation, the trial showed that fluid boluses were associated with an increased mortality compared to no-bolus (control), the greatest effect was in children with the most severe forms of shock. We were delighted when the FEAST trial won the prestigious 2011 BMJ Research Paper of the Year award and expected that doctors around the world would sit up and take notice – and guidelines for management of children suffering from shock due to sepsis would change.

However, five years on, I have to say that I am disappointed that the WHO guidelines in resource-poor settings are still largely unaltered. Although the humanitarian aid charity Medicins sans Frontieres changed its own procedures within nine months of our results becoming public, the directing and coordinating agency for international health of the United Nations has so far left existing guidelines in place. This is despite the fact that we found that the intervention of rapidly administering fluids was actually harmful to children in our study which was robust and based on sound scientific evidence. One statistician said it was the most consistent he had ever seen. (more…)

International Youth Day, plenty of reasons to celebrate

By Professor Beate Kampmann, Professor of Paediatrics and Director of IGHI’s Centre for International Child Health (CICH)

August 12 is International Youth Day.

This special day was created by the United Nations in 1999 to recognise efforts of the world’s youth in enhancing global society.

The theme of this year has been put forward by the UN as “The Road to 2030: Eradicating Poverty and Achieving Sustainable Production and Consumption”.  In my opinion this theme sets out an over-ambitious agenda, and many of our International Youth might feel overwhelmed by the responsibilities it implies.  It represents a far-reaching goal, not only for “Youth”, defined as 15-24 year olds, but for people of all ages.

Eradicating poverty? Since when have adolescents shouldered the burden of poverty eradication? What influence do they have on sustainable production and consumption, when too often they are victims of child labour themselves and their consumption is determined by powerful industries and the politics and expectations of the societies in which they happen to grow up?

  • The UN should not be asking or quietly demanding International Youth work towards eradication of poverty, sustainable production and consumption.
  • This remains the job and responsibility of members of society who own power, money and who wield political clout. It is they whose job it is to ensure that the future of the “International Youth” is less affected by these global issues.

However, there are many examples of important contributions of “International Youth” that ought to be acknowledged and celebrated on August 12.  In many resource-poor settings, adolescent girls and boys work tirelessly for their families to at least contribute to the amelioration, if not eradication, of the poverty in their individual households. Many are exploited in doing so, sacrificing their own educational opportunities. (more…)

From women’s health to women empowerment

By Guest blogger Natasha Chainani 

With it being International Womens Day this week, I thought it would be apt to recognise breakthrough innovations in women’s hygiene that have been doing the rounds of social media lately. Even more so, it would be apt to recognise that women’s health need not be pioneered by women alone by highlighting the efforts of a common man turned social entrepreneur and frugal innovator in rural India taking the feminine hygiene industry by storm.

Photo courtesy of Asian Development Bank, Flickr

In a country where sanitary products remain a luxury and accessible to those who can afford to buy pricier, international brands, women still resort to traditional methods – often unhygienic and at risk of disease[1]. Although the momentum to spread awareness around menstruation and feminine hygiene is picking up, stigma to talk about it by households and the larger society largely remains. Rightly so, these barriers continue to impact improvement efforts around women’s health in developing countries.

Arunachalam Muruganantham (Photo courtesy TED@Bangalore)

Enter Arunachalam Muruganantham. Hailing from a simple family in Coimbatore, India and educated till school1, he was brought to realise the dire state of feminine hygiene in rural, low resource and poor communities when he noticed his wife having to choose between purchasing family meals and monthly sanitary supplies[2].  A market research study by AC Nielsen evaluated that 88% of women in India resort to using unhygienic practices such as ash, dried leaves and newspapers when faced with a lack of sanitary supplies, putting 70% of these women at risk of reproductive tract infections and associated cancers[3]. Driven by what he saw, Arunachalam Muruganantham set out on an uphill task to develop low-cost sanitary towels from available resources. After years of development and product-testing trials, he now holds the patent rights for a machine that not only manufactures low-cost, hygienic sanitary towels but its user-friendly technology has created jobs for women in an industry setting he built. The manual machine costs about £723, employs 10 women, produces 200-250 cotton pads and can supply 3000 women at a cost of £0.025 for each towel1. Small-scale businesses and not-for-profit organisations currently buy these machines to directly manufacture and sell these sanitary towels across 27 states in India3. (more…)