THE LUCINA PROJECT
AN OBSERVATIONAL STUDY OF TWO KENYAN HOSPITALS
Although there has been great progress in global health within the past decade, we still see a huge gaps between maternal and neonatal health in high and low-income countries. Sepsis is the leading cause of maternal death in Sub-Saharan Africa, a region that sees some of the highest rates of maternal mortality and morbidity in the world. As one of the most commonly performed surgical procedures in SSA and a proven risk factor for surgical site infection, cesarean section is an important operation to target due to its massive impact on maternal and neonatal health. However, there is currently insufficient published data available on the patient and facility-based context around SSI following CS to establish a true and clear understanding of this infectious category.
The Lucina Project was a pilot study aimed at gathering high quality data on surgical site infections following cesarean section in Kenya, in partnership with our colleagues at Kenyatta University School of Medicine. Dr. Anthony Wanyoro, Chairman of the Department of Obstetrics and Gynecology, served as our Principal Investigator and provided crucial guidance and support. We were also lucky to work with Amos Ndhere and his team at Clinical RM-Africa, a contract research organization.
We targeted two district level government hospitals outside of Nairobi, enrolling 600 patients from September to December of 2016. Due to an intervention implemented some years prior to our study by Dr. Alexander Aiken of the London School of Hygiene and Tropical Medicine, one of these hospitals administered pre-operative antibiotics to all patients. The second hospital exclusively administered post-operative antibiotics.
“[The] maternal mortality ratio – the proportion of mothers that do not survive childbirth compared to those who do – in developing regions is still 14 times higher than in the developed regions.”
–Source: United Nations
The data collected showed a striking difference between SSI rates in patients who were given properly timed pre-operative antibiotics and patients who were only given post-operative antibiotics. Administration of post-operative antibiotics is currently the norm in much of SSA and there is strong evidence that many of the infectious problems encountered in this population would be reduced by the provision of antibiotic prophylaxis prior to the incision.
This project demonstrated both that high quality data may be collected in facilities of this type without extensive investment of resources or training, and that the effects of pre-operative antibiotics override many deficiencies that cannot be addressed without changes in infrastructure. We are currently working on an expansion of this project.
Priscilla Wangari Kimani
Our board members and collaborators are some of the leading professionals in surgery and infection prevention
DR. ANTHONY WANYORO
Dr. Anthony Wanyoro (MBChB, MMED in OBGYN) is the Senior Lecturer and Chairman of the Department of Obstetrics and Gynecology at the School of Health Science of Kenyatta University. He has been involved in several collaborative research efforts including targeting surgical site infection in Kenya and is also currently the Head of an RCT/PHD program on the use of mobile phone SMS as a call recall tool in cervical cancer screening in resource pool areas. Additionally, he has developed a manual on surgical site infection prevention in resource constrained settings.
He has conducted research in the area of infection following cesarean section.
DR. LUCAS TINA
Investigator/Consultant (Clinical RM)
Dr. Tina (MBChB, MSc. PHDC, DLSHTM) is a physician and public health researcher with over 10 years of experience in clinical trials. He has served as the Co-Investigator of a Pneumococcal vaccine trail and as Principal Investigator of a polio vaccine evaluation for the Kenya Medical Research Institute. Dr. Tina is also the recent recipient of a grant from the GalaxoSmithKline Trust in Science.
DR. AMOS NDHERE
Clinical Investigator (Clinical RM)
Dr. Ndhere holds a position at Gertrude's Garden Children Hospital in Nairobi and serves as a consultant for the Africa Infectious Disease Village Clinics program. He has successfully collaborated on NIH funded projects by the Center for Global Health at Northwestern University and The University of Michigan.
DR. RAPHAEL KINUTHIA
Dr. Kinuthia has an educational background in Biological Sciences, Epidemiology, and Clinical Cytology, and has also trained extensively in Reproductive Health and HIV, Integrated Disease Surveillance and Response, and Responsible Conduct of Research and Bioethics. For fifteen years, Dr. Kinuthia worked as a Clinical Cytologist at Vineyard Hospital and various Family Health Care clinics in Kenya. He is currently the Projects Coordinator at the School of Medicine of Kenyatta University.