Maternal Health in Southern Africa

For many women around the world, pregnancy is a time of discovery.

Routine screenings aim to protect mothers and their fetuses from infectious diseases such as HIV, hepatitis, syphilis, chlamydia, gonorrhea, and trichomoniasis. Jeffrey Klausner, MD, MPH, clinical professor of population and public health sciences has been working in Southern Africa since 2009 conducting research on sexually transmitted diseases. His current research in South Africa and Botswana aims to address preventable pregnancy conditions such as preterm birth, which is the leading cause of infant mortality. His study in Botswana revealed that among pregnant women who received routine screening and treatment, there was a reduction in pre-term birth and low-birth weight.

“In high resource settings, pregnant women are routinely screened for many infections. If they test positive—they receive treatment. This is not being done with 90% of pregnant women globally, because of lack of strong evidence and research, political-will, and cost-effectiveness,” reports Klausner. His lab aims to bridge this health equity gap through building the evidence base.

Klausner’s lab has received substantial US government and private funding to combine their infectious disease treatment strategy with other interventions to improve maternal health in this region. This study will run for the next five years, rigorously testing a new intervention in Botswana. Participants will take one combined pill-a-day, comprised of antibiotics; multivitamins beyond iron and folate; and low dose aspirin to prevent inflammation—which causes preeclampsia in women with high blood pressure. Findings from studies like this, can influence major policy changes across low- and middle-income country settings when informing standard of care.

Doing this work at a university provides tremendous training opportunities. The research team includes post-graduates, research associates, PhD candidates, medical and master’s students, and undergraduates in the U.S. and abroad. Through student development, his projects are investing in the next generation of medical scientists through a ‘learning-while-doing’ model.

Klausner’s engagement spans across various collaborators from the community base to the national level. In the Eastern Cape of South Africa, predominantly Xhosa women in rural settings are enrolled in his research, contrasting, the pregnant women in publicly funded clinics in urban areas in Gaborone, Botswana. Similarly, his projects have fostered lifelong relationships with other researchers in the US and internationally. Currently, his lab partners with stakeholders on the national policy committees that correspond to the health areas he is investigating, facilitating translation of this research into national policy.

A big threat to development of this work is antimicrobial resistance (AMR) that undermines drug efficacy. To address this concern, Klausner is working to develop new diagnostics that immediately detect AMR which informs the appropriate use of treatments. Similarly, he advises on new antibiotic development, which gives rise to the potential to switch treatment and combat the overuse of any single antibiotic.

Klausner’s contributions in this space not only improve inequities experienced in maternal and child health at a community level, but augment the health infrastructure through faster diagnostics, new treatments, development of best practices and training of experts, to support sustainable health systems in lower resource settings.