Randomized controlled trials are needed to close the evidence gap in the prevention of preterm birth

Kwegyir-Afful, Emma; Ijaz, Sharea; Räsänen, Kimmo; Verbeek, Jos

doi:10.5271/sjweh.3396

Cited by 5 publications

(7 citation statements)

References 19 publications

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“…Strenuous physical activity, low birthweight and preterm birth are common occurrences in low-income countries without guidelines to protect against hazardous work exposures [11]. There are inconsistencies in the existing etiological studies on the subject thereby creating an evidence gap [22]. As a result of the inconsistencies, recommendations and all other clinical guidelines lack the necessary evidential backing for practice.…”

Section: Discussionmentioning

confidence: 99%

“…In their quest to lengthen gestational age, midwives in LMICs such as Ghana, advise pregnant women against strenuous physical activity. In certain conditions, the pregnant woman is admitted to a hospital throughout the gestational period to ensure complete bed rest to avert possible preterm birth [22]. Besides, there are several occupational guidelines formulated by various institutions [19,23] aimed at protecting pregnant employees against physical stress in their respective countries.…”

Section: Introductionmentioning

confidence: 99%

“…More recent are the provisional clinical guidelines for occupational lifting in pregnancy by MacDonald et al [24] but none of such guidelines exist in Ghana and other LMICs. Moreover, a recent systematic review revealed that no trial has investigated the usefulness of such guidelines aimed at reducing heavy lifting among pregnant women to increase gestational age [22]. The 3-component lift-less intervention (LLI) consisting of clinical guidelines of occupational lifting in pregnancy by MacDonald et al [24] coupled with a shopping voucher will be implemented.…”

Section: Introductionmentioning

confidence: 99%

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A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women: Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial (Preprint)

Kwegyir-Afful¹,

Verbeek²,

Aziato³

et al. 2018

Preprint

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Background: Preterm birth (PTB) is a leading cause of infant morbidity and mortality in the world. Every year 20 million babies are born with low birthweight (LBW) and about 96% occurring in low-income countries. Despite their associated dangers, in about 40-50% of PTB and LBW cases, the causes are unexplained. Existing evidence is inconclusive as to whether occupational physical activities such as heavy lifting are implicated. African women bear the transport burden of accessing basic needs for their families. Ghana's preterm birth rate is 14.5% as compared to the global average of 9.6%. The proposed lift-less intervention aims to decrease lifting exposure during pregnancy among Ghanaian women. Our hypothesis is, a reduction in heavy lifting among pregnant women in Ghana will increase gestational age and birthweight.Method: A cohort stepped-wedge cluster randomized controlled trial in 10 antenatal clinics will be carried out in Ghana. A total of 1,000 participants will be recruited for 60 weeks period. To be eligible participant's pregnancy should be singleton between 12 to 16 weeks gestation, attending any of the 10 antenatal clinics and exposed to heavy lifting. All participants will receive standard antenatal care within the control phase and by random allocation; two clusters will transit into the intervention phase. The midwife-led 3-components lift-less intervention consists of health education, a take-home reminder card mimicking the colours of traffic light and a shopping voucher. The primary outcome will be gestational age at <28, 28-32 and 33-37 weeks. Secondary outcomes are LBW (preterm LBW, term but LBW and post term), compliance, prevalence of low back and pelvic pains and premature uterine contractions.Objective: To investigate the effects of the lift-less intervention on the incidence of prematurity and low birthweight among Ghanaian pregnant women. Results:The results of the trial will be published in a peer reviewed journal. It will increase knowledge in the prevention of PTB and low birth weight worldwide. Conclusion:To the best of our knowledge, there has been no randomized trial of this nature in Ghana. Minimizing heavy lifting among African pregnant women can reduce the soaring numbers of preterm and LBW.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women: Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial (Preprint)

Kwegyir-Afful¹,

Verbeek²,

Aziato³

et al. 2018

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…In their quest to lengthen gestational age, midwives in LMIC such as Ghana advise pregnant women against strenuous physical activity. In certain conditions, the pregnant woman is admitted to a hospital throughout the gestational period to ensure complete bed rest to avert possible PTB [ 22 ]. Several occupational guidelines have been formulated by various institutions [ 19 , 23 ] aimed at protecting pregnant employees against physical stress in their respective countries.…”

Section: Introductionmentioning

confidence: 99%

“…However, no such guidelines exist in Ghana and other LMIC. A recent systematic review revealed that no trial has investigated the usefulness of such guidelines aimed at reducing heavy lifting among pregnant women to increase gestational age [ 22 ]. The 3-component liftless intervention implemented in this trial is based on the clinical guidelines of occupational lifting in pregnancy by MacDonald et al [ 24 ] coupled with a shopping voucher.…”

Section: Introductionmentioning

confidence: 99%

A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women: Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial

et al. 2018

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BackgroundPreterm birth (PTB) is a leading cause of infant morbidity and mortality worldwide. Every year, 20 million babies are born with low birthweight (LBW), about 96% of which occur in low-income countries. Despite the associated dangers, in about 40%-50% of PTB and LBW cases, the causes remain unexplained. Existing evidence is inconclusive as to whether occupational physical activities such as heavy lifting are implicated. African women bear the transport burden of accessing basic needs for their families. Ghana’s PTB rate is 14.5%, whereas the global average is 9.6%. The proposed liftless intervention aims to decrease lifting exposure during pregnancy among Ghanaian women. We hypothesize that a reduction in heavy lifting among pregnant women in Ghana will increase gestational age and birthweight.ObjectiveTo investigate the effects of the liftless intervention on the incidence of PTB and LBW among pregnant Ghanaian women.MethodsA cohort stepped-wedge cluster randomized controlled trial in 10 antenatal clinics will be carried out in Ghana. A total of 1000 pregnant participants will be recruited for a 60-week period. To be eligible, the participant should have a singleton pregnancy between 12 and 16 weeks gestation, be attending any of the 10 antenatal clinics, and be exposed to heavy lifting. All participants will receive standard antenatal care within the control phase; by random allocation, two clusters will transit into the intervention phase. The midwife-led 3-component liftless intervention consists of health education, a take-home reminder card mimicking the colors of a traffic light, and a shopping voucher. The primary outcome are gestational ages of <28, 28-32, and 33-37 weeks. The secondary outcomes are LBW (preterm LBW, term but LBW, and postterm), compliance, prevalence of low back and pelvic pain, and premature uterine contractions. Study midwives and participants will not be blinded to the treatment allocation.ResultsPermission to conduct the study at all 10 antenatal clinics has been granted by the Ghana Health Service. Application for funding to begin the trial is ongoing. Findings from the main trial are expected to be published by the end of 2019.ConclusionsTo the best of our knowledge, there has been no randomized trial of this nature in Ghana. Minimizing heavy lifting among pregnant African women can reduce the soaring rates of PTB and LBW. The findings will increase the knowledge of the prevention of PTB and LBW worldwide.Trial RegistrationPan African Clinical Trial Register (PACTR201602001301205); http://apps.who.int/trialsearch/ Trial2.aspx?TrialID=PACTR201602001301205 (Archived by WebCite at http://www.webcitation.org/71TCYkHzu)Registered Report IdentifierRR1-10.2196/10095

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Manual handling of burdens as a predictor of birth outcome—a Finnish Birth Register Study

Kwegyir-Afful

Lamminpää

Selander

et al. 2018

European Journal of Public Health

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Randomized controlled trials are needed to close the evidence gap in the prevention of preterm birth

Cited by 5 publications

References 19 publications

A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women: Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial (Preprint)

A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women: Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial (Preprint)

A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women: Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial

Manual handling of burdens as a predictor of birth outcome—a Finnish Birth Register Study

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