ENhancing Intergenerational HeAlth in Nigeria: Peripartum as Critical Life StagE for CardioVascular Health (ENHANCE-CVH)

增强尼日利亚的代际健康：围产期是心血管健康的关键生命阶段 (ENHANCE-CVH)

• 批准号: 10672827
• 负责人: GODWIN OTUODICHINMA AKABA
• 金额: $ 61.71万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-05 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672827
• 关键词: Adopted; Adoption; Birth; Body Weight; Body Weight decreased; Body mass index; Capital; Cardiac; Cardiovascular Diseases; Certification; Child; Childhood; Cluster randomized trial; Collaborations; Communities; Community Health; Community Health Nursing; Coupled; Data; Development; Diabetes Mellitus; Diet; Dietary Practices; Disadvantaged; Discipline of obstetrics; Disease; Education; Educational Status; Educational process of instructing; Effectiveness; Enrollment; Evaluation; Family; Funding; Funding Opportunities; Grant; Growth; Gynecology; Health; Health Educators; Health Policy; Health behavior; Health system; Healthy Eating; Home; Home visitation; Hybrids; Hypertension; Infant; Intervention; Lead; Life; Live Birth; Maintenance; Maternal Age; Maternal Health; Maternal Mortality; Methods; Modeling; Modification; Mothers; New York; Nigeria; Nigerian; Nurses; Nursing Faculty; Obesity; Outcome; Outcome Assessment; Overweight; Parents; Perinatal; Physical activity; Policies; Pregnant Women; Prevention; Primary Health Care; Primary Schools; Public Health; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Research Personnel; Rural; Safety; Societies; Subgroup; Sustainable Development; System; Testing; Trainers Training; Training; Uncertainty; United States National Institutes of Health; Universities; Washington; Weight; Woman; Work; active lifestyle; antenatal; budget impact; burden of illness; cardiovascular health; effectiveness evaluation; effectiveness outcome; effectiveness testing; evidence base; follow-up; gestational weight gain; implementation outcomes; implementation research; implementation science; improved; infancy; intergenerational; low and middle-income countries; maternal morbidity; maternal weight; member; peri-urban; post intervention; postpartum weight; pregnancy disorder; prenatal; primary health center; recruit; sex; teacher; trend; trial design; tribal Nation

PROJECT ABSTRACT Nigeria has among the highest burdens of maternal morbidity and mortality, including an estimated 528 (95% uncertainty intervals: 351, 815) maternal deaths per 100,000 lives birth in 2019 (global average: 152 per 100,000). This rate far exceeds the UN Sustainable Development Target 3.1: <70 maternal deaths per 100,000 live births by 2030. Nigeria also has a large and rising burden of noncommunicable diseases, including overweight/obesity, hypertension, diabetes mellitus, and cardiovascular diseases. Unhealthy changes in dietary patterns and physical activity contribute to these adverse trends, especially during critical life stages, such as the peripartum period, infancy, and childhood. Improving maternal health behaviors and subsequent maternal cardiovascular health is a central strategy toward improving family cardiovascular health to blunt and eventually reverse the rising burden of noncommunicable diseases in Nigeria. Nigeria's National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases and National Task Shifting and Sharing Policy are new and relevant policy frameworks that will be leveraged to improve intergenerational cardiovascular health among Nigerians in this proposal. The objective of this study is to test effectiveness and implementation of an adapted HEALTH (Healthy Eating Active Living Taught at Home) intervention on intergenerational cardiovascular health among 1,000 pregnant women with obesity recruited during the antenatal period through a type 2 hybrid cluster randomized (1:1) trial implemented in 40 Nigerian primary healthcare centers. Using the Framework for Reporting Adaptations and Modifications-Expanded, the HEALTH intervention and its implementation will be adapted from the evidence-based, Parents as Teachers home visiting model from the US that has been used and validated by Washington University researchers, including in the NIH-funded ENRICH consortium. We will use a train-the-trainer model including certified trainers to step down training to community health extension workers and community nurse health educators. The primary effectiveness outcome will be change in maternal body weight from baseline to 18-month follow-up with >85% power to detect a between-group of difference of 2.5 kg. Secondary effectiveness outcomes include changes in maternal cardiovascular health. Exploratory outcomes include changes in infant and child growth. Safety data will be collected. RE-AIM will guide quantitative and qualitative implementation outcome assessment, and reach will be the primary implementation outcome with a >50% target of recruiting women with primary school education or less. Our team of US and Nigerian investigators at Washington University, University of Abuja, and New York University have collaborated for >5 years with support from 5 active NIH grants. We have strong support from key Nigerian stakeholders, including at local, state, and national levels. Thus, our proposal is highly feasible, efficient, likely to succeed, responsive to this funding opportunity, aligned with NIH and GACD priorities, and will be mutually beneficial to our team members through embedded capacity building.

项目摘要 尼日利亚是孕产妇发病率和死亡率负担最高的国家之一，估计有528人 (95%不确定区间：351，815）2019年每10万例孕产妇死亡（全球平均值：152/ 100，000）。这一比率远远超过联合国可持续发展目标3.1：每10万人中孕产妇死亡人数<70人 到2030年的活产。尼日利亚还面临着巨大且不断上升的非传染性疾病负担，包括 超重/肥胖、高血压、糖尿病和心血管疾病。不健康的变化， 饮食模式和体育活动助长了这些不利趋势，特别是在生命的关键阶段， 如围产期、婴儿期和儿童期。改善产妇保健行为， 孕产妇心血管健康是改善家庭心血管健康的核心战略， 最终扭转尼日利亚日益严重的非传染性疾病负担。尼日利亚国家多部门 预防和控制非传染性疾病行动计划和国家任务转移， 共享政策是新的相关政策框架，将用于改善代际关系， 心血管健康在这一提案中。本研究的目的是测试有效性， 实施适应性健康（健康饮食，积极生活，在家里教）干预， 研究期间招募的1,000名肥胖孕妇的代际心血管健康状况， 通过在40名尼日利亚小学生中实施的2型混合随机化（1：1）试验， 保健中心。使用扩展的适应和修改报告框架， 干预措施及其实施将适应以证据为基础，家长作为教师的家 来自美国的访问模型已被华盛顿大学的研究人员使用和验证，包括 在NIH资助的ENRICH联盟中。我们将使用培训师模型，包括认证培训师， 对社区卫生推广人员和社区护士健康教育工作者进行培训。主 有效性结果将是母体体重从基线到18个月随访的变化，>85% 检测2.5 kg组间差异的把握度。次要有效性结局包括变化 在孕产妇心血管健康方面。探索性结果包括婴儿和儿童生长的变化。安全 将收集数据。RE-AIM将指导定量和定性的实施成果评估， reach将是主要的执行成果，其目标是征聘小学毕业的妇女超过50% 我们的美国和尼日利亚研究小组在华盛顿大学，阿布贾大学， 和纽约大学已经合作了超过5年，并得到了5个国家卫生研究赠款的资助。我们有强大 尼日利亚主要利益攸关方的支持，包括在地方、州和国家各级。因此，我们的建议是， 高度可行、高效、可能成功、响应这一资助机会，与NIH和GACD保持一致 优先事项，并将通过嵌入式能力建设对我们的团队成员互惠互利。