The Gates grant—the largest single grant to the School of Nursing—will enable Lynn Sibley (above) and her collaborators in the United States and Ethiopia to create a community-based model to improve survival rates for mothers and infants.
$8.12 million Gates grant supports safe childbirth in Ethiopia
In rural Ethiopia, as in many developing countries, giving birth is often a matter of life and death. More than 90% of births take place at home, and 25,000 women die each year from complications. The lifetime risk of dying during childbirth is 1 in 27, and the infant mortality rate is 77 deaths per 1,000 live births.
Lynn Sibley, a nurse-midwife, anthropologist, and clinical associate professor of nursing, is determined to turn the situation around through a project funded with $8.16 million from the Bill & Melinda Gates Foundation. The grant is the single largest ever awarded to the School of Nursing.
For the next 2 1/2 years, faculty and graduate students from Emory will work with the Ethiopian Ministry of Health to create a community strategy to improve maternal and newborn health in rural Ethiopia. Their approach will serve as a model throughout the country.
“The sustainable approaches this grant helps us create will mean the difference between life and death, quite literally, for increasing numbers of Ethiopian families,” says School of Nursing Dean Linda McCauley.
Joining Sibley on the project are Maureen Kelley, a nurse-midwife and clinical associate professor in the School of Nursing; Rob Stephenson, assistant professor of global health in the Rollins School of Public Health; and Craig Hadley, assistant professor of anthropology in Emory College. A co-principal investigator based in Ethiopia will participate in the project and be eligible for a faculty appointment at Emory.
"Both mothers and babies are most vulnerable during birth and the early postnatal period—up to about 48 hours. This period of vulnerability provides a window of opportunity to intervene to make a significant contribution to maternal and newborn survival and well-being."
Lynn Sibley, director, Center for Research on Maternal and Newborn Survival
Team members will partner with Regional Health Bureaus in Ethiopia, the John Snow Research and Training Institute, the University Research Co. LLC, and two regional Ethiopian universities. Collaborators will help improve the capability and performance of frontline health care workers, including health extension workers, community health volunteers, and traditional birth attendants, in providing targeted maternal and newborn services around the time of birth. They also will work to increase the demand for these services and promote healthy self-care behaviors.
“Both mothers and babies are most vulnerable during birth and the early postnatal period—up to about 48 hours,” says Sibley, whose work has touched the lives of families and health workers in several developing countries. “This period of vulnerability provides a window of opportunity to intervene to make a significant contribution to maternal and newborn survival and well-being. We know what to do, but we need to learn how to better reach and engage women and their newborns at this critical time.”
The leading causes of maternal death globally are hemorrhage, eclampsia, obstructed labor, and sepsis. For newborns, the leading factors are lack of oxygen during labor and delivery and sepsis, often compounded by low birth weight due to preterm birth or failure to grow well during pregnancy.
“In settings where home birth is still the norm and health services are being strengthened, safe, clean care during labor, delivery, and the postnatal period are critical to survival,” says Sibley.
Key to the success of the Ethiopia project is teaching a set of simple, yet critical procedures that birth attendants or family caregivers can perform. Procedures include care at delivery for both mother and child, a postpartum health assessment of mother and child, and counseling on nutrition, personal hygiene, and illness recognition and care seeking. Instructors will distribute and use these packages to promote collaborative improvement of health care quality district-wide.
According to the World Health Organization, Ethiopia has 80 million people, 85% of whom live in rural areas, and the world’s ninth-highest birth rate. With a 90% rate of home births, a community approach to care is essential. Sibley’s project will promote broad adoption of this strategy, strengthen federal and local capacity to do so, and provide tools and methods for expanding the program across the country.
The Ethiopia project is based in the Center for Research on Maternal and Newborn Survival, which Sibley directs. The center is part of the Lillian Carter Center for International Nursing (LCCIN), through which faculty and students participate in service learning and research to improve health for vulnerable populations. The Gates grant will broaden the reach of the research center, the LCCIN, the School of Nursing, and the Emory Global Health Institute, a university partner.
“Dr. Sibley is a vital leader in her field,” says Kathryn Kite, LCCIN administrative director. “The excitement surrounding her work in Ethiopia will attract new faculty and create new projects that build on one another.”
Global health is a key component of Campaign Emory, the university’s $1.6 billion fund-raising initiative. With the Gates grant, the school’s campaign total is $18.5 million. The campaign goal for the School of Nursing is $20 million.—Maria Lameiras
Average number of maternal deaths: per 100,000 births as of 2005
United States:11 Bangladesh: 570 Ethiopia: 720
Source: WHO, 2007.
Maria Lameiras is an editor for campaign communications at Emory. Photos provided by Lynn Sibley.