The Centre of Research Excellence (CRE) to Reduce Inequality in Heart Disease focuses on improving the heart health and outcomes of groups and communities i.e. Regional Australians, Indigenous Australians and International Health

Protect Africa study


Research Stream: International health / Individuals living in low-to-middle income countries


Educational levels in young African women remain at historical lows. This provides a particular challenge when attempting to optimise the health of mothers and babies through educational strategies. It is estimated that up to one in two pregnant women in urban communities like Soweto are either overweight or obese. This poses a challenge to the heart health of both generations. In response, our group has pilot data showing the utility of an innovative information technology (IT)-based program to provide readily accessible and understandable health education to this vulnerable population.


Full Study Title

Pregnancy-Related Obesity prevention Through Education & Communication Technology in AFRICA:



Funding Sources

This study is predominantly supported via local and national funding sources with additional support from the Baker IDI Heart and Diabetes Institute via the NHMRC CRE to Reduce Inequality in Heart Disease. The study also receives critical support from the Medtronic Foundation.


Rationale for the Study

One of the most important public health strategies is health education intervention that aims to promote healthy lifestyles and choices.  On a global scale, the female literacy rate is lowest in Africa and has many disparities. The female literacy rate in South Africa is 80% compared to Niger which is only 10%. Moreover, a mother’s education level is closely correlated to the risk of child death before the age of 2 [6]. In South Africa the lack of education attainment in some females could possibly be associated with the early initiation of childbearing [2] or the aftermath from the education system during the apartheid era.


In developing countries women have a double burden of disease, with the prevalence of mortality in pregnant women being closely linked to HIV/AIDS, postpartum haemorrhage and cardiovascular diseases. The global obesity pandemic is associated with increased incidence of diabetes and hypertension, all of which increase the probability of cardiovascular disease.  During pregnancy these cardiovascular risk factors affect both the mother and foetus [8,10].


Maternal obesity is a major contributing and modifiable risk factor for foetal and perinatal health [5]. As a result of overnutrition by the mother, she has an increased risk of becoming preeclampsic [1,9], undergoing preterm delivery [4] and the foetus being macrosomic [7], all of which have the potential to increase the mortality rate of stillbirths and perinatal death. A newborn whose mother is obese is most likely to die within 2 years of birth [3].


The World Wide Web (i.e. the Internet) and advanced forms of Information Technology (IT) is being used increasingly as a resource for accessing health-related information. Everyday people interact with the Internet to access information, because of its convenience as well as its ease of use. However, unequal access to health information via technological tools (i.e. internet, computer etc) is a major problem around the world. Therefore, implementing tools to ensure universal access to knowledge is of the utmost importance.


Thus, given poor maternal health and outcomes, the potential importance of effective health education, keeping in mind the possible low educational levels within the maternal population, we will prospectively examine the impact of a health education-IT-based intervention package on excess weight gain in slightly overweight African pregnant women, as well as the direct potential beneficial implications it has on the newborn.


Study Aims & Hypotheses

The primary aim of the study is to investigate whether overweight but not obese pregnant African women having ad libitum access to a health education-IT based intervention package fall within the lowest quartile for excess weight gain (


Therefore, we hypothesize that ad libitum access to health education via an IT-based intervention package has the potential to reduce the onset of obesity in African pregnant women as well as improve the health outcomes of their newborn baby.   


Study Design

The PROTECT-AFRICA Study is a multi-centre, appropriately powered, randomised controlled trial of an integrated, Information Technology-based educational intervention programme, to minimise the risk of excessive weight gain in overweight (but not obese) pregnant African women versus an enhanced form of usual care. The study will screen 1200 patients from four primary care clinics; two in Soweto and two in Cape Town, from which 480 participants will be recruited. The study will conform to CONSORT guidelines for pragmatic trials [11] and adhere to the “Declaration of Helsinki”. A prospective health-economics design analysis will examine the potential cost-benefits of the intervention to significantly reduce the proportion of pregnant women experiencing excessive weight gain (with associated adverse health outcomes) from a health service payer perspective. Data will also be extrapolated to a whole-of-community and health system-wide perspective.


Potential Study Outcomes

The primary outcome will be the proportion of participants who gain > 12kg from 16 weeks to delivery. Key secondary outcomes for the mother is a change in Body Mass Index, body composition, body perception, change in health knowledge, change in food choices, plasma micronutrient levels (vitamin C and folic acid), change in systolic and diastolic blood pressure, number of caesarean births, treatment for infection post-delivery, the occurrence of obstetric haemorrhages and the effect of health coaching via SMS technology (the SMS content will be based on the content from the video’s on the HeduAfrica site). Furthermore, the study outcomes for the newborn include, size of infant (weight), Apgar score, blood pressure and plasma vitamin C levels.


Ongoing Research/Translational Potential

The results from the PROTECT-Africa study could potentially influence South African health care policies (i.e. creating more cost effective and efficient interventions) and provide a fresh perspective on the impact of maternal obesity in South Africa.


Key Collaborators

Key References

  1. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004;103(2):219-24.
  2. Cochrane, S.H. & World Bank. Fertility and education: What do we really know?  World Bank, The Johns Hopkins University Press, Baltimore and London. 1979; xii + 175.
  3. Cresswell JA, Campbell OM, De Silva MJ, Filippi V. Effect of maternal obesity on neonatal death in sub-Saharan Africa: multivariable analysis of 27 national datasets. Lancet. 2012;380(9850):1325-30.
  4. Doherty DA, Magann EF, Francis J, Morrison JC, Newnham JP. Pre-pregnancy body mass index and pregnancy outcomes. Int J Gynaecol Obstet. 2006;95(3):242-7.
  5. Kanagalingam MG, Forouhi NG, Greer IA, Sattar N. Changes in booking body mass index over a decade: retrospective analysis from a Glasgow Maternity Hospital. BJOG. 2005;112(10):1431-3.
  6. Kickbusch IS. Health literacy: addressing the health and education divide. Health Promot Int. 2001;16(3):289-97.
  7. Kumari AS. Pregnancy outcome in women with morbid obesity. Int J Gynaecol Obstet. 2001;73(2):101-7.
  8. Samadi AR, Mayberry RM, Zaidi AA, Pleasant JC, McGhee N, Jr., Rice RJ. Maternal hypertension and associated pregnancy complications among African-American and other women in the United States. Obstet Gynecol. 1996;87(4):557-63.
  9. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001;25(8):1175-82.
  10. Seely EW, Ecker J. Clinical practice. Chronic hypertension in pregnancy. N Engl J Med. 2011;365(5):439-46.
  11. Zwarenstein M, Treweek S, Gagnier JJ, Altman DG, Tunis S, Haynes B, Oxman AD, Moher D. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ. 2008;337:a2390.

Study Publications

  • None present at the moment