Reducing Preeclampsia Morbidity and Mortality in LMIC Through Clinical Risk Stratification Protocols Incorporating the Urine Congo Red Test

Preeclampsia is a leading cause of maternal morbidity and mortality worldwide. The risk of death is ~300-fold higher in LMIC where the disease is less likely recognized early enough for transfer to facilities adequately equipped for treatment. The recurring barrier has been the lack of preeclampsia-specific diagnostic tests practically suitable for LMIC. Our proposal is for in scale-up and in country implementation of the Congo Red Test, a novel diagnostic test for preeclampsia based on urine congophilia. From studies funded by SL@B we learned that most women reaching tertiary centers in LMIC already have severe disease (and high urine congophilia) making it too late for live-saving interventions such as administration of magnesium sulfate. For the greatest impact, we propose testing the feasibility of implementing the Congo Red Test at antenatal care (ANC) facilities in primary or secondary level facilities in Bangladesh, Uganda and Ethiopia where we aim to identify congophilic women who are currently missed despite being ill. At the end of this Phase 1 stage (24 months) we expect to build the capacity to conduct a stepped wedge clinical trial in at least two LMIC countries.