Taking On a Leading Killer of Children Worldwide

A single solution won’t remedy the problem of premature birth in East Africa, so researchers with UCSF’s Preterm Birth Initiative focus on new ideas to save newborns.

Premature birth is the leading cause of death worldwide among children younger than 5 years old. Every year, 15 million preemies are born worldwide – 60 percent of them in South Asia and sub-Saharan Africa – and 1 million of them die shortly after birth. Many who survive face a lifetime of serious health complications. 

UCSF’s Dilys Walker, MD (above), a professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, is dedicated to reducing the burden of prematurity. Her goals include improving hospital-based care during the crucial period before, during, and immediately after delivery and developing and testing new interventions that reduce prematurity-related death and health issues. 

Walker’s work in Kenya, Uganda, and Rwanda is part of the Preterm Birth Initiative (PTBi) at UCSF. PTBi has two branches – one in East Africa that Walker heads and one in California, led by Larry Rand, MD

Walker’s team’s efforts focus on implementation and discovery science: Where during this critical period can improvement have the most impact, and what strategies or interventions work best? 

“One solution alone isn’t going to remedy preterm birth,” Walker says, “so our global research team focuses on trying new ideas like group prenatal care, testing evidence-based interventions, and investing in new technologies and discoveries.” 

For example, in Rwanda, where attendance at prenatal visits is low, they conduct research to determine whether group prenatal care can improve the experience of care and reduce preterm birth. Anecdotes from the field indicate the women are bonding and supporting one another, exchanging phone numbers, and pooling their money for emergencies and for layettes for the poorest among them. 

In Uganda and Kenya, the strategy revolves around quality improvement, including a novel birth-simulation training that Walker and a partner developed. In collaboration with the nongovernmental organization PRONTO International, her team trains health care workers in obstetric and neonatal emergency response to improve their performance. The approach lets health care providers practice their skills in high-stress situations to ensure appropriate responses during an actual emergency. 

These and other interventions are beginning to show promise, and Walker hopes to soon make a dent in those prematurity numbers. 

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