MUII-plus’ Dr. Nakimuli among 2020 FLAIR Fellowship recipients

Dr. Annettee Nakimuli, a Makerere University lecturer and MUII-plus Group Leader, is one of 29 recipients of the 2020 Future Leaders – African Independent Research (FLAIR) fellowships announced by the African Academy of Sciences (AAS) and the Royal Society with support from UK’s Global Challenges Research Fund (GCRF),.

The scheme supports African researchers to develop into science leaders while establishing independent research careers on the continent.

The 2020 cohort of FLAIR funded scientists were selected from a competitive pool of more than 400 applicants. This second cohort joins the first intake in 2019 of FLAIR fellows, who are already making a significant contribution to science on the continent in their fields.

Outstanding early-career African scientists, whose research is focused on the needs of the continent, will be supported by the Future Leaders – African Independent Research (FLAIR) programme to develop independent research careers in African institutions and ultimately, lead their own research groups.

Annettee’s area of interest is Pre-eclampsia in women of African origin. As part of her FLAIR fellowship she hopes to conduct follow-up studies of more than 1500 Ugandan women before and after birth to develop a test for risk of pre-eclampsia.

We had a chance to talk to Dr. Nakimuli on a one on one about her next plans;

Tell us about yourself and your research interests

I am an Associate Professor and the Head of the Department of Obstetrics and Gynaecology at Makerere University, in Uganda. I am a researcher and also a practicing obstetrician and gynaecologist. My clinical expertise is high risk obstetrics (complicated pregnancies) and I work at Kawempe National Referral Hospital and Mulago Specialized Women & Neonatal Hospital which are the main teaching Hospitals for Makerere University. My primary research interest is pre-eclampsia, a hypertensive disorder in pregnancy and a major cause of maternal morbidity and mortality in sub-Saharan Africa. In particular, I am interested in identifying genetic and other risk factors for pre-eclampsia in order to improve pregnancy outcomes in Ugandan mothers. I am also interested in researching about other pregnancy complications common in Ugandan women such as fetal growth restriction, preterm birth, intrauterine fetal death and pathogen infections during pregnancy. These studies aim at development of tools that will improve prediction, management and prevention of pregnancy complications.

What will you be working on with the FLAIR fellowship?

The number of women and newborns dying during pregnancy and childbirth remains unacceptably high especially in Sub Saharan Africa (SSA). Pre-eclampsia, which is a fatal hypertensive disorder of pregnancy, is a major contributor to this maternal and perinatal morbidity and mortality. Though the cause of pre-eclampsia remains unclear, early disease detection improves maternal and fetal outcomes.  There is an urgent need to develop new methods to identify women at risk of pre-eclampsia to improve outcomes for both mother and baby. Attempts to identify pregnant women at risk of adverse outcomes have had little success. To address this, pregnancy follow-up studies have been conducted in high-income-countries (HIC) to develop better screening approaches but these studies poorly represent the biological and socio-economic conditions in SSA. Therefore, I aim to conduct a follow-up study of 1,512 Ugandan women, getting them immediately after conception. We shall perform repeated ultrasound scans and blood sampling throughout pregnancy and at the time of birth. This study will facilitate development of a test which identifies women at high risk of pre-eclampsia and its complications in SSA and will facilitate conducting more research in future.

How serious is the problem of pre-eclampsia in Uganda? Why should people care about your research?

• Why is pre-eclampsia important?
• It is a common disease that affects 5-8 % of all pregnancies world.
• It contributes to 16% of maternal deaths (women dying in pregnancy, child birth or after birth) worldwide. This translates to 76,000 maternal deaths per year.
• It also contributes significantly to death of newborns, causing death of 500,000 infants per year.
• Pre-eclampsia in Uganda
• One of the leading causes of maternal and infant death in Uganda especially in referral and national referral hospitals.
• Pre-eclampsia is responsible for 11 % of maternal deaths per year in Uganda (estimated to be 600 pre-eclampsia deaths per year).
• Difficult to establish the burden of pre-eclampsia in Uganda but is estimated to be 4% of the annual births (~1,000,000), that is, 40,000 women per year.

How will this award help you achieve your long term career plans?

Performing this study will give me experience in the design, organisation and management of a large prospective clinical study. This experience will be extremely valuable in achieving my ultimate aim, which is to lead randomised clinical trials utilising novel predictive tools for screening and intervention to impact on the burden of disease in SSA. I will also be exposed to the analysis and interpretation of screening data, cohort and case control analyses, and more complex longitudinal analyses of variables that change with time. Again, this will provide a strong foundation for effective planning of future interventional studies as well as achieve my aim of becoming a leader in women’s health in SSA.

What are the big challenges in your research area?

• Funding is very competitive
• Involving pregnant women in research has ethical and practical challeges, especially during the emergency environment

What advice would you give to researchers looking to apply for a FLAIR fellowships?

• They should invest a lot of time in writing a winning proposal.
• Should look at the type of projects funded so as to properly align their proposals
• Should ensure that their projects address research priority areas for Africa