The United States and Nigeria may be an ocean apart, but each has distressingly high rates of infant and maternal death in the year following childbirth. In 2021, the Centers for Disease Control and Prevention (CDC) estimated the U.S. maternal mortality rate to be nearly 33 deaths per 100,000 births — about 10 times higher than such rates in several other high-income counties. And in Nigeria, it’s much worse: According to the World Health Organization, the rate is more than 530 deaths per 100,000 births.
To reduce these numbers and save lives, researchers at Washington University in St. Louis and the University of Abuja in Abuja, Nigeria, have received grants to work with community organizations in St. Louis and Abuja, with both projects partnering with Parents as Teachers, a national organization in the U.S. that has long provided support to young families through home visits. Building on the existing home-visiting model, the goal of these programs is to improve cardiovascular health for the mother during pregnancy and for the entire family following delivery. The funds, from two grants totaling $9 million, are from the National Institutes of Health (NIH).
“Nigeria has one of the highest maternal mortality rates in the world,” said cardiologist Mark Huffman, MD, a professor of medicine and co-director of the Global Health Center at Washington University. “And in the U.S., Missouri also has high rates of death during and soon after pregnancy. Many of these deaths are due to hypertensive disorders in pregnancy, especially high blood pressure that can lead to heart failure, seizures, strokes and death. Tragically, these are often preventable conditions. We know what works to lower blood pressure, and the programs we are developing here and in Nigeria are intended to get those interventions to the people who need them most.”
The programs will help families manage their cardiovascular health, and embed healthy eating, physical activity, stress management, sleep and tobacco prevention information and activities within the Parents as Teachers’ curriculum. The teams will aim to help participants control other risk factors for cardiovascular disease, including body weight, blood pressure and blood sugar during and after pregnancy. The researchers will follow the families’ progress, continuing home visits and data collection until the children reach age 2.
“We are taking a multigenerational approach to improving cardiovascular health in families by targeting interventions to the earliest stages of pregnancy and childhood,” said cardiologist Victor Davila-Roman, MD, a professor of medicine, of anesthesiology and of radiology at the School of Medicine. Davila-Roman also serves as director of the Global Health Center, a joint effort between the Institute for Public Health and the Department of Medicine at Washington University.
In St. Louis, the program — Enhancing Cardiovascular Health Equity in Mothers and Children through Home Visiting — is led by principal investigators Debra Haire-Joshu, PhD, the Joyce and Chauncy Buchheit Professor in Public Health at Washington University, Davila-Roman, and Rachel Tabak, PhD, an associate professor at the Brown School. Washington University’s program is one of the seven clinical centers funded to do similar work across the U.S. as part of the NIH’s Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH) program.
In Nigeria, the newly funded program — Enhancing Intergenerational Health in Nigeria: Peripartum as Critical Life Stage for Cardiovascular Health (ENHANCE-CVH) — is led by principal investigators Huffman, who has had long-standing collaborations with colleagues at the University of Abuja; Davila-Roman; Dike Ojji, MBBS, PhD, an associate professor and chair of the Department of Internal Medicine at the University of Abuja; and Godwin Akaba, MBBS, an associate professor and an obstetrician and gynecologist at the University of Abuja.
“We are excited about these two programs, because they promise to be so interactive,” Haire-Joshu said. “There will be so many opportunities for us to learn from one another about the best ways to impart knowledge of cardiovascular health to new, young families. We anticipate learning about new strategies in Abuja that also can work here in St. Louis and vice versa. This is a perfect example of the local-to-global — and back again — collaborations that we’re interested in building between St. Louis and communities around the world.”
Added Dike Ojji, of the University of Abuja: “This program is so important, because cardiovascular diseases and the risk factors, such as hypertension, are the most common causes of mortality and morbidity during pregnancy in Nigeria and Africa as a whole. We are hopeful the program will receive support from the Federal Ministry of Health of Nigeria as it aligns with their policy of reducing maternal and fetal morbidity and mortality.”
In both St. Louis and Nigeria, the researchers are working with Parents as Teachers, a national organization that started and is based in St. Louis. Trained professionals with Parents as Teachers support young families through regular home visits during pregnancy and early childhood, with the aim of partnering with parents to support their child’s development; support positive parent and child interactions; improve parenting practices; boost child and family school readiness; and improve family, caregiver and child health, among other goals.
Past studies involving this program indicate that home visits with young families help them develop healthy habits that nurture early childhood development. The hope is that adding the latest heart health science to the existing approach will cultivate new habits that improve the cardiovascular health of the entire family. Such habits, once established, ultimately also could improve the health of future generations.
“Collaborations between Washington University and Parents as Teachers go back some 25 years,” said Allison Kemner, senior vice president and chief research officer for the Parents as Teachers National Center, which is headquartered in St. Louis. “With this latest partnership, we are taking health interventions shown to help with weight control and diabetes management, for example, and embedding them into the existing Parents as Teachers program. When Washington University brings the science and Parents as Teachers brings the practice with the families, together they can have a powerful effect.”
In Nigeria, the researchers will adapt interventions developed with Parents as Teachers in St. Louis and implement them in Abuja, training community health workers and nurses who work as community health educators to deliver messages about heart health during regular home visits.
The programs will focus on families at highest risk of cardiovascular disease burden, including Black and Hispanic families in St. Louis, families experiencing socioeconomic disadvantages, those affected by obesity, and those in which the parents have a primary school education or less.