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Cassandra Rene, PhD Student 

GHES U.S. Fellow 2018-2019

FELLOWSHIP SITE: GHESKIO; Haiti
U.S. INSTITUTION: FLORIDA INTERNATIONAL UNIVERSITY

Project Title: An Educational Intervention to Increase Awareness, Knowledge, and Self-Assessment Skills of Peripartum Cardiomyopathy in Haiti

In contrast to the average maternal mortality rate of 68 deaths per 100,000 live birth in the Caribbean, Haiti has one of the highest maternal mortality rates, with 359 deaths per 100,000 live births. These rates are partly due to delays in seeking medical assistance in obstetric emergencies, reaching an appropriate obstetric facility, and receiving adequate care at the obstetric facility. One of the medical contributors to this high maternal mortality rate in Haiti is Peripartum Cardiomyopathy (PPCM). Peripartum Cardiomyopathy is a disease of the heart which manifests in pregnant women during their last month of pregnancy and up to 5 months postpartum. It causes the muscle to have difficulty to contract and effectively pump blood. As a result, this strain can cause the heart to become weaker and lead to heart failure. Cardiomyopathy shares many of the same signs and symptoms that will naturally present themselves in pregnant women. Therefore, pregnant women can develop cardiomyopathy and attribute their signs and symptoms to their pregnancy. In Haiti, the incidence of PPCM is about one case per 300 live births compared to one case per 3,000 to 4,000 live births in the United States. Of the one PPCM case per 300 live births in Haiti, PPCM is responsible for about 47.1 maternal deaths per 100,000 live births in Haiti, in contrast to 0.62 maternal deaths per 100,000 live births in the United States. The aims of this will be to:

Aim 1: Assess the knowledge, attitudes, and practices (KAP) of health professionals and auxiliary personnel regarding heart failure and Peripartum Cardiomyopathy in Haiti and approaches to addressing these conditions in pregnant and early post-partum women.

Aim 2: Assess psychosocial and structural barriers to seeking, reaching, and receiving care for heart failure among HIV+ and HIV- pregnant women, as guided by the Three Delays Model.

Aim 3: Translate and adapt the Fett self-test based on a total of four focus groups with health professionals and auxiliary personnel and refine the measure based on cognitive interviews with 14-16 members of a Community Advisory Board (CAB) including HIV+ and HIV- women of childbearing age.