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Multidisciplinary sickle cell disease obstetrics care program in Ghana: Non-academic vs.Academic Hospital (Pilot Study)

Award Number: K43TW012579
ORGANIZATION: FOGARTY INTERNATIONAL CENTER
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/11/2023
PERIOD OF PERFORMANCE END DATE: 04/30/2028

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Multidisciplinary sickle cell disease obstetrics care program in Ghana: Non-academic vs.Academic Hospital (Pilot Study) - Pregnancy in sickle cell disease (SCD) is a life-threatening complication associated with 22.81 (95% CI: 14.67–35.46) increased odds of maternal death in low- and middle-income countries;1 From 2012–2014, the Obstetrics Department at Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, established an obstetrician-led SCD Obstetrics clinic. The Institutional maternal mortality for SCD over these three years (2012–2014) was ~12%.2 In January 2015, a multidisciplinary SCD obstetrics team was established. The team conducted a combined retrospective/ prospective case series of all maternal deaths in women with SCD at KBTH over seven years (2010–2016).3 This retrospective data collection highlighted failures and challenges to delivering improved care. Acute chest syndrome, preceded by acute pain episodes, was the leading cause of death in nearly 87% of women.3 In May 2015, the team implemented a joint obstetrics/ hematology clinic, instituted close maternal and fetal monitoring, and implemented clinical guidelines/ protocols. These interventions resulted in an 89.1% risk reduction in maternal mortality (from 10,791 to 1,176 deaths per 100,000 live births; p=0.007) over 13 months.2 Since initiating the multidisciplinary SCD obstetrics program, KBTH has consistently decreased maternal mortality in this cohort by ~90% compared to before the program was established.4,5 This mentored award aims to extend our results of decreasing maternal mortality from an academic hospital to a non-academic hospital in Accra, Ghana, with a current maternal mortality rate of 7,921 per 100,000 live births in women with SCD. In a before-and-after study design, the awardee will test the hypothesis that multidisciplinary care and task-shifting in a non-academic hospital for pregnant women with SCD will have a 50% relative risk reduction in death compared to the mortality rate in the same hospital before the multidisciplinary SCD obstetrics care approach. The specific aims are: 1) Identify contextual determinants (barriers/ facilitators) that influence the adaptability of the evidence-based practice for establishing a multidisciplinary SCD obstetrics team as an intervention in the non-academic hospital, including the implementation process (Years 1-2); 2) Build capacity for a multidisciplinary SCD obstetrics program in a non-academic hospital (Years 3-5), and 3) Conduct a Hybrid type 1 feasibility study comparing the effectiveness of a task-shifted multidisciplinary SCD obstetrics program in a non-academic site (Years 3-5). The high clinical volume of pregnant women with SCD at the Greater Accra Regional Hospital (a non-academic hospital with ~150 deliveries annually) provides a unique, non-replicable opportunity for rigorous training, protocol development, and implementation research that is not feasible in lower-volume U.S. centers. This foreign component enables efficient development and evaluation of multidisciplinary care models that can be adapted to improve maternal outcomes for women with SCD in the U.S., where such models remain underdeveloped due to limited patient numbers.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $85,310 )
2026	2026	COLLEGE OF HEALTH SCIENCES, UNIVERSITY OF GHANA	CHARLES EASMON BUILDING	ACCRA				GHA	International Research and Research Training	000	4	6/1/2026	NON-COMPETING CONTINUATION	$85,310
														Subtotal = $85,310

Issue Date FY: 2025 ( Subtotal = $85,310 )
2025	2025	COLLEGE OF HEALTH SCIENCES, UNIVERSITY OF GHANA	CHARLES EASMON BUILDING	ACCRA				GHA	International Research and Research Training	002	3	5/19/2025	NON-COMPETING CONTINUATION	$85,310
2025	2024	COLLEGE OF HEALTH SCIENCES, UNIVERSITY OF GHANA	CHARLES EASMON BUILDING	ACCRA				GHA	International Research and Research Training	001	2	3/25/2025	NON-COMPETING CONTINUATION	$0
2025	2023	COLLEGE OF HEALTH SCIENCES, UNIVERSITY OF GHANA	CHARLES EASMON BUILDING	ACCRA				GHA	International Research and Research Training	000	1	3/25/2025	NEW	$0
														Subtotal = $85,310

Issue Date FY: 2024 ( Subtotal = $85,320 )
2024	2024	COLLEGE OF HEALTH SCIENCES, UNIVERSITY OF GHANA	CHARLES EASMON BUILDING	ACCRA				GHA	International Research and Research Training	000	2	4/25/2024	NON-COMPETING CONTINUATION	$85,320
														Subtotal = $85,320

Issue Date FY: 2023 ( Subtotal = $85,310 )
2023	2023	COLLEGE OF HEALTH SCIENCES, UNIVERSITY OF GHANA	CHARLES EASMON BUILDING	ACCRA				GHA	International Research and Research Training	000	1	8/14/2023	NEW	$85,310
														Subtotal = $85,310

Grand Total All Awards = $341,250

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Multidisciplinary sickle cell disease obstetrics care program in Ghana: Non-academic vs.Academic Hospital (Pilot Study)

Award Number: K43TW012579

ORGANIZATION: FOGARTY INTERNATIONAL CENTER

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/11/2023

PERIOD OF PERFORMANCE END DATE: 04/30/2028

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