Women’s Health and Child Survival

A woman waits outside a clinic in Zambia. Photo: Jorge Alberto Perez

A woman waits outside a clinic in Zambia. Photo: Jorge Alberto Perez

In the developing world, women and children are particularly vulnerable. Each year more than 300,000 women die due to complications during childbirth. More than 5.2 million babies do not survive their first month of life.  The IGHID has a commitment to women worldwide to conduct research that improves the health of women and their children, provide direct health services, and build local skills and capacity for the long-term benefit of communities.

UNC is home to the largest global women’s health division in the world. Established in 2012, it has an interdisciplinary team of doctors and researchers dedicated to improving health for women and children in the developing world.  Through our established programs in Malawi, Nicaragua and elsewhere, we are helping to train local health care workers in emergency obstetric procedures, provide simple cancer screenings that save women’s lives, and bring critical vaccines to tens of thousands of children.

Program Areas

Emergency Obstetrics and Fistula (Malawi)

A fistula is a medical condition that develops after a prolonged or failed childbirth when adequate medical care is not available. Fistulas cause leaking from the bladder and/or bowels, and in addition to the physical problems, women with fistulas face devastating social consequences, often being abandoned by their husbands, families and communities. Fistulas and forms of obstructed labor account for 8 percent of maternal deaths worldwide. The Malawi Maternal and Neonatal Health program, led by Dr. Jeff Wilkinson, seeks to improve the safety of childbirth in Malawi and help address the devastating problem of obstetric fistula through obstetric fistula prevention, treatment, and post-surgical reintegration and an individualized emergency obstetrics and neonatal care training program for Malawian health workers (see Training, below). A comprehensive obstetric fistula database facilitates a research to examine characteristics associated with development of fistula and successful surgical repair. The program is a partnership between UNC, the U.S. Centers for Disease Control, and the UK-based Freedom from Fistula Foundation.

An infant is weighed at the antenatal clinic at Bwaila Maternity Hospital, Lilongwe, Malawi. Photo: Caitlin Kleiboer.

An infant is weighed at the antenatal clinic at Bwaila Maternity Hospital, Lilongwe, Malawi. Photo: Caitlin Kleiboer.

Prevention of Mother-to-Child Transmission of HIV  (Malawi)

Together with the Malawi Ministry of Health, UNC Project-Malawi is rolling out universal ART for all pregnant and breastfeeding women. This program provides almost half of all PMTCT services in Malawi and is the largest HIV counseling and testing program in sub-Saharan Africa. A monitoring and evaluation team addresses operational issues related to the rollout of PMTCT and ART activities and best practices for the integration of additional services, including tuberculosis screening, malaria control, family planning and laboratory services. Faculty and trainees conduct research activities around point-of-care testing, implementation of cell phone-based data collection, modification of ART eligibility guidelines, and family planning integration.

Family Planning (Malawi)

UNC investigators have completed studies evaluating the feasibility and acceptability of immediate postpartum intrauterine device placement and interactions between HIV, antiretrovirals and hormonal contraception. They are also completing a one-year prospective cohort study evaluating the family planning knowledge, attitudes, and practices of 600 postpartum women; a needs assessment of family planning providers at 14 Lilongwe District Health Centres; and an operational research project to integrate a package of family planning interventions into the President’s Safe Motherhood Initiative.

Child Vaccines (Malawi and Nicaragua)

Diarrhea is the second biggest killer of children under 5 worldwide. Rotavirus is a leading cause of gastrointestinal problems, including diarrhea, in young children. Nicaragua was one of the first low- and middle-income countries to implement universal rotavirus immunization.  Since 2007, UNC has been collaborating with the University of Nicaragua (UNAN) and the Nicaraguan Ministry of Health to evaluate the impact of universal rotavirus immunization in Nicaragua. The goals of this project include assessing changes in diarrhea incidence at the community level, changes in seeking care for diarrhea in public health facilities, changes in the common etiologies of childhood diarrhea, and potential shifts in rotavirus genotypes following vaccine introduction. Contact: Sylvia Becker-Dreps, MD.

Malaria also disproportionately affects children under 5. In partnerships with the PATH Malaria Vaccine Initiative and GlaxoSmithKline, UNC is conducting clinical trials of a malaria vaccine in Malawi. Thus far the vaccine, RTS,S, has been shown to reduce the number of malaria cases in young children by almost 50 percent and to reduce malaria in infants by 27 percent.

Training

Global Women’s Health Fellowship (Zambia and Malawi)

UJMT Fogarty Global Health Fellows Program (13 countries)

Doris Duke International Clinical Research Fellowship (Malawi and China)

OB-GYN Residency Program for Malawians (Malawi )

Who’s Involved

Jeff Stringer, MD (Director, UNC Global Women’s Health)

Sylvia Becker-Dreps, MD, MPH

Benjamin Chi, MD

Irving Hoffman, PA, MPH

Mina Hosseinipour, MD, MPH

Groesbeck Parham, MD

Gretchen Stuart, MD

Jennifer Tang, MD

Selected Recent Publications

Stringer JS. Safe pregnancy in the world’s poorest countries begins with access and ends with the obstetricians (Obstetrics and Gynecology, 2013).

Schwartz SR, Pettifor A, Stuart GS, Cohen MS. Hormonal contraception and HIV: the methods have confused the message (AIDS, 2013).

Stringer JS. Improving health information systems for decision making across five sub-Saharan African countries: Implementation strategies from the African Health Initiative (BMC Health Services Research, 2013)

Panozzo CA, Becker-Dreps S, Pate V, Jonsson Funk M, Stürmer T, et al. Patterns of Rotavirus Vaccine Uptake and Use in Privately-Insured US Infants, 2006-2010 (PloS One, 2013).

Becker-Dreps S, Meléndez M, Liu L, Zambrana LE, Paniagua M, Weber DJ, et al. Community diarrhea incidence before and after rotavirus vaccine introduction in Nicaragua (American Journal of Tropical Medicine and Hygiene, 2013).

Macklaim JM, Cohen CR, Donders G, Gloor GB, Hill JE, Parham GP, et al. Exploring a road map to counter misconceptions about the cervicovaginal microbiome and disease (Reproductive Sciences, 2013).

Stringer JS, Chisembele-Taylor A, Chibwesha CJ, Chi HF, Ayles H, Manda H, et al.Protocol-driven primary care and community linkages to improve population health in rural Zambia: the Better Health Outcomes through Mentoring and Assessment (BHOMA) project (BMC Health Services Research, 2013).

Chi BH, Bolton-Moore C, Holmes CB. Prevention of mother-to-child HIV transmission within the continuum of maternal, newborn, and child health services (Current Opinion in HIV and AIDS, 2013).

Parker ME, Tembo M, Adair L, Chasela C, Piwoz EG, et al. The health of HIV-exposed children after early weaning (Maternal and Child Nutrition, 2013).

Stuart GS, Moses A, Corbett A, Phiri G, Kumwenda W. Combined oral contraceptives and antiretroviral PK/PD in Malawian women: pharmacokinetics and pharmacodynamics of a combined oral contraceptive and a generic combined formulation antiretroviral in Malawi (Journal of Acquired Immune Deficiency Syndrome, 2012).

White HL, Mulambia C, Sinkala M, Mwanahamuntu MH, Parham GP, et al. Motivations and experiences of women who accessed “see and treat” cervical cancer prevention services in Zambia (Journal of Psychosomatic Obstetrics and Gynecology, 2012).

Sahasrabuddhe VV, Parham GP, Mwanahamuntu MH, Vermund SH. Cervical cancer prevention in low- and middle-income countries: feasible, affordable, essential (Cancer Prevention Research, 2012).

Wilkinson JP, Lyerly AD, Masenga G, Hayat SK, Prabhu M. Ethical dilemmas in women’s health in under-resourced settings (International Journal of Gynecology and Obstetrics, 2011).