Adandani, literally “one who leans”, is the slang word for a pregnant woman in the Mamprusi language, spoken in Northern Ghana. Here we see three adandanis, however with straight backs, waiting for a check-up in an abandoned schoolhouse used for mobile clinics in Gbangu-Nagbo, Northern Ghana. Photo: William Haun.

Trial will give answers to effects of heavy lifting during pregnancy

One in seven livebirths in Ghana is premature. This is the fourteenth highest rate in the world, and about three times higher than in Sweden and Finland. Public health-researcher Emma Kwegyir-Afful has set out to find the causes of this high incidence.

Emma Kwegyir-Afful, who is currently on a PhD-scholarship at the Nordic Africa Institute, has been working for more than 20 years as a nurse and midwife in Ghana and Finland. On several occasions she has witnessed the many problems associated with preterm birth (PTB).

“Besides an increased risk of the new-born child dying at a young age, prematurity also raises the risk of lifelong physical or neurological disability”, says Kwegyir-Afful, who is doing her doctoral studies at the University of Eastern Finland in Kuopio.

Studying 1,000 pregnant women
Strenuous physical activity is usually considered one of the main causes of PTB, but a systematic review by Kwegyir-Afful published in the Scandinavian Journal of Work, Environment & Health, shows that there is an evidence gap in the literature on the causes and prevention of prematurity. Globally, the causes of between 40 and 45 per cent of the spontaneous PTB are unknown.

“Women have been advised to avoid heavy lifting during pregnancy, in order to decrease the risk of premature delivery, but there is no research evidence on the effectiveness of this advice. To close this evidence gap, I plan to do a cluster randomised controlled trial of 1,000 pregnant women at 10 different antenatal clinics in Ghana”, says Kwegyir-Afful.

One observation group, one education group
The study will be done by dividing the women into two groups of 500. One group will just be observed, the other will receive health education based on the clinical guidelines for occupational lifting during pregnancy.

“The aim is to reduce their daily activity involving heavy lifting and carrying. The guidelines are relatively simple and easy to teach; avoid lifting objects weighing more than 10 kg, divide bigger objects into smaller portions before lifting, avoid lifting items overhead or one-handed, and don’t lift straight from the floor”, Kwegyir-Afful explains.

The women in the treatment group will also be given a take-home reminder card with a simplified content that mimics the colours of a traffic light.

“The red light explains circumstances when the pregnant women should immediately report to the clinic or seek a midwife’s assistance. The yellow light talks of what pregnant women should think twice about before lifting and carrying. And finally the green light gives advice on how to do the lifting and carrying”, says Kwegyir-Afful. She adds that the folder needs to be visually self-explanatory, since a number of participants are likely to be illiterate or non-English speaking.

All is set to go
The study will last 60 weeks and Kwegyir-Afful, who is in the third year of her doctoral studies, is eager to get started. But there is one tiny detail holding her back – money.

“All is set to go. We’ve got green lights from the ethical review boards of both the Ghana Health Service and University of Eastern Finland, and the project has been properly registered according to the rules of trial procedures recommended by the WHO. I have all the necessary contacts with all the 10 clinics in which I’ll be selecting and training the midwives for the study. And thanks to the Nordic Africa Institute, I now also have the take-home reminder card in place. But the estimated cost for the whole project is 230,000 euros and so far I’ve just managed to get funding to conduct a pilot study, which I’ll be starting in August”, Kwegyir-Afful concludes.

FACTS | PTB, Preterm Birth

  • PTB is the birth of a baby after less than 37 weeks of pregnancy
  • PTB is the most common cause of death among infants worldwide
  • PTB increases the risks of cerebral palsy and delays in development.
  • About 15 million babies are born preterm each year
  • Across 184 countries, the rate of PTB ranges from 5 to 18 per cent of babies born
  • In Ghana, the PTB-rate is 14 per cent, almost three times higher than Sweden (5.9) and Finland (5.5).

Emma Kwegyir-Afful had long experience in working as a nurse and midwife and in training other midwives before coming to Finland for her PhD studies.

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