Funding

The GREAT Network has held threerounds of seed grant competitions to date to support projects in the area of knowledge synthesis and implementation of evidence-based guidelines to optimize maternal and infant health in low and middle income countries (LMICs). To date, a total of 5 projects have been funded by the GREAT Network seed grants.

Round One: Knowledge to Action (or Implementation) Seed Grant Projects

Project 1 (awarded $10,000.00 CAD)

Country: Uganda

Project title:
Evaluating the effect of implementation a multi-component intervention of academic detailing, SMS reminders and feedback on correct and persistent use of partograph at the point of care in rural Uganda: A before-after feasibility intervention.

Project summary:
This implementation project, led by a study team in Uganda, aims to inform policy on barriers, facilitators, opportunities, and the feasibility of the correct and persistent use of partograph. The World Health Organization (WHO) recommends partograph use for the prevention and management of prolonged or obstructed labour because it has the potential to improve maternal and fetal outcomes. However, in many low-resource settings, including Uganda, the tool is underutilized, and many health care providers do not have the knowledge and skills to use it properly.

The project proposes to implement a new training approach called “academic detailing”, which includes SMS reminders, regular supervision, and feedback to improve partograph use. The novelty of this training approach is that it combines elements of ‘good practice’ into one cohesive bundle that, when implemented, improves both the quality of care patients receive and patient outcomes.

Project 2 (awarded $10,000.00 CAD)

Country: Sri Lanka

Project title:
Improving quality of perinatal health care in Sri Lanka. Proposal for assessing and improving adherence to WHO guidelines on management of maternal complications at hospital level.

Project summary:
This implementation project, led by Professor Hemantha Senanayake in Sri Lanka, aims to systematically evaluate the current level of adherence to selected relevant WHO guidelines in the largest referral maternity hospital in Sri Lanka. It also aims to enhance implementation of guidelines into clinical practice and to develop local capacities on case management and quality improvement (QI) approaches. Despite considerable progress in the last years, Sri Lanka’s maternal and child health (MCH) services still present several problems and weaknesses. Based on existing epidemiological data, the following three major obstetrics conditions were selected for the project: 1) postpartum haemorrhage (PPH); 2) pre-eclampsia; and 3) induction of labour (IOL).

The WHO Quality Assurance/Quality Improvement Tool is being used to carry forward a comprehensive evaluation of: a) adherence to the WHO guidelines; b) availability and appropriate use of resources; and c) relevant hospital policies and organization of services. A database has been developed to collect data for all deliveries that are occurring in the Professorial Obstetric Unit of a hospital in Sri Lanka. Checklists for PPH, severe pre-eclampsia, and induction of labour, have also been developed based on WHO and local guidelines and in conjunction with the collaborators from the University of Trieste, Italy. This project will inform on adherence to relevant WHO guidelines in the main maternity hospital in Sri Lanka, and will provide the basis to develop local capacities, instruments, and experiences to eventually scale up this process, in conjunction with all interested parties and stakeholders.

Hemantha Senanayake is a professor in Obstetrics & Gynaecology in the Faculty of Medicine at the University of Colombo, Sri Lanka. Prof. Senanayake’s special interests include acute obstetrics, instrumental delivery, endometriosis, and quality improvement.

Project findings:

The GREAT Network Knowledge to Action (or Implementation) seed grant funding opportunity aims to facilitate the implementation of knowledge to enhance the quality of care in low and middle income countries. This funding is targeted towards knowledge translation (KT) projects focused on optimizing maternal and infant health outcomes, using the relevant World Health Organization (WHO) evidence-based clinical guidelines. This podcast features work done by Dr. Hemantha Senanayake and his team as part of their seed grant funded project: Improving quality of perinatal health care in Sri Lanka. Proposal for assessing and improving adherence to WHO guidelines on management of maternal complications at hospital level.

To listen to the podcast, please click here.

To read the podcast transcript, please click here.

Round Two: Knowledge Synthesis Seed Grant Projects

Project 3 (awarded $10,000.00 CAD)

Country: Italy

Project titles:
Review # 1: Impact of the facility-based individual case Near-Miss Reviews in improving the Quality of Maternal and Newborn Care in low and middle income countries (LMIC): systematic review and meta-analysis.

Review # 2: Facilitators and barriers to successful implementation of the facility-based individual case Near Miss Reviews in LMIC: a qualitative systematic review.

Project summary:
This knowledge synthesis project, led by Dr. Marzia Lazzerini at the Institute for Maternal and Child Health, IRCCS Burlo Garofolo in Italy, consists of two systematic reviews. The first review will systematically explore the impact of Near-Miss Reviews on improving quality of care for mothers and newborns in LMICs. The second review will identify facilitators and barriers to successful implementation of the Near-Miss Review approach in LMICs. These complementary reviews will inform a number of stakeholders on the evidence beyond the Near-Miss approach, the benefit of the approach, and ultimately, how it can be used more effectively to reduce the global burden of maternal mortality and morbidity. The systematic reviews will also inform an upcoming guidance manual of the World Health Organization (WHO) regional Office for Europe.

Dr. Lazzerini has been the director of the WHO Collaborating Centre for Maternal and Child Health of Trieste (WHO CC) since 2011. Before 2011, she worked as a clinical paediatrician in a third level hospital in Italy, as well as in LMICs. In 2004, after a Diploma in Tropical Medicine and Hygiene at the Liverpool School of Tropical Medicine, she joined the Cochrane Collaboration, and since then she has authored several systematic reviews, and collaborated with WHO on the development of about 20 guidelines. In 2006. Dr. Lazzerini completed a MSc in Methods of Clinical Research with the Cochrane Centre, and in 2009 she obtained a PhD in Clinical Research in Paediatrics. During that time she also accumulated field experience in Sub-Saharan Africa, South America, South East Asia, and the WHO European Region. Her main area of interest in maternal and child health includes quality of care. For more information, please visit: www.burlo.trieste.it/content/area-ricerca-scientifica/cooperazione-internazionale.

Project findings:

The GREAT Network Knowledge Synthesis seed grant funding opportunity aims to support the completion or updating of knowledge syntheses, including systematic reviews and scoping reviews, that are relevant to maternal and infant health in low and middle income countries. This podcast features work done by Dr. Marzia Lazzerini and her team as part of their seed grant funded project. Dr. Lazzerini and her team conducted two systematic reviews:

  • Review # 1: Impact of the facility-based individual case Near-Miss Reviews in improving the Quality of Maternal and Newborn Care in low and middle income countries (LMIC): systematic review.
  • Review # 2 : Facilitators and barriers to successful implementation of the facility-based individual case Near Miss Reviews in LMIC: a qualitative systematic review.

To listen to the podcast, please click here.

To read the podcast transcript, please click here.

Project 4 (awarded $5,000.00 CAD)

Country: China

Project title:
Intervention for emergency contraception: An update of a systematic review and meta-analysis

Project summary:
This project, led by Dr. Yan Che at the Shanghai Institute of Planned Parenthood Research (SIPPR) in China, consists of a systematic review and meta-analysis focused on interventions for emergency contraception (EC). The project aims to determine and update, from the best evidence available, which EC method is the most effective, safe, and convenient to prevent unintended pregnancy following unprotected intercourse. The project also aims to enhance the understanding of EC as a vital part of the whole effective contraceptive system. Outcomes of this review will update the knowledge of EC that will benefit both service providers and EC users.

Dr. Che is a Principal Investigator and the head of the Centre for Clinical Trial and Training at SIPPR, a World Health Organization (WHO) Collaborating Centre for Research in Human Reproduction and a leading institute in the research of reproductive health in China. Dr. Che received his MD and MPH from Fudan University and his PhD in Epidemiology and Public Health from London School of Hygiene & Tropical Medicine (LSHTM). Dr. Che has worked at SIPPR since 1995, during which he has been involved in over 40 research projects, focusing on family planning, fertility, infertility, abortion, infant health, and population policy. His research has led to the removal of once-a-month pills, visiting pills, and medicated ring 165 from free contraceptive services in China as well as changes in contraceptive promotion strategy in Shanghai. He is currently involved in an EU funded project integrating post-abortion family planning services into China’s existing abortion services in hospital settings. He has published over 80 peer-reviewed papers and serves as an ad hoc reviewer for scientific journals including the Lancet, BMJ, Plos One, Contraception, Studies in Family Planning, and Reproduction & Contraception.

Project findings:

The GREAT Network Knowledge Synthesis seed grant funding opportunity aims to support the completion or updating of knowledge syntheses, including systematic reviews and scoping reviews, that are relevant to maternal and infant health in low and middle income countries. This podcast features work done by Dr. Yan Che and his team as part of their seed grant funded project. Dr. Che and his team conducted a systematic review titled: Intervention for emergency contraception: update of a systematic review and meta-analysis.

To listen to the podcast, please click here.

To read the podcast transcript, please click here.

Round Three: Knowledge to Action (or Implementation)

Project 5 (awarded $10,000.00 CAD)

Country: Ethiopia

Project title:
Evaluation of Knowledge Translation interventions for the PPH prevention and treatment program based on the WHO PPH guideline

Project summary:

The World Health Organization Country Office (WCO) is the lead United Nations agency in supporting governments in the adoption of evidence based guidelines in to a national context. So far the WCO has supported the FMOH on preparation of national Obstetric protocols for hospitals and health centres which is the sole guideline used by service providers for management of common Obstetric complications including post-partum Haemorrhage (PPH). Based on those protocols a training package on Basic Emergency Obstetric and New born Care (BEmONC) was also prepared which is used for capacity building of service providers. At different times job aids are also printed and distributed to facilities for Active Management of Third Stage of Labour (AMTSL) and MgSO4 administration both at hospital and health centre level.

The project objectives are:

General Objective: To evaluate the effectiveness and acceptability of the PPH prevention and management intervention package at selected health facilities in Ethiopia.

Specific Objective

  • To evaluate the effect of establishing PPH/Haemorrhage task forces/advisory group at national and regional levels
  • To evaluate the effectiveness of availing a separate national guideline on PPH prevention and management and the AMTSL and other PPH job aids
  • To examine the added advantages of availing Skilled Health workforce trained on PPH prevention and treatment for improving quality of MH services
  • To assess advantages of doing regular quality improvements assessments and

Orientation on PPH prevention and management

Mixed methods (quantitative and qualitative), two phased approach will be used to evaluate the Knowledge Translation interventions for the PPH prevention and treatment program based on the WHO PPH guideline. Phase 1 will be a base line assessment in selected heath facilities that will be done with multiple stakeholders on existing situation on prevention and management of PPH, the perspectives of policy makers, program managers and also in the health facilities with front line health workers. It will also include a facility survey on availability of guidelines, job aids, drugs, trained manpower for PPH prevention and management. This will be followed by the implementation of the PPH intervention package that will be implemented for one year time.  The phase 2 of this study will be conducted after the intervention has been implemented and it will try to see the progresses made and the effectiveness of the PPH intervention package in the same selected facilities.