Round 2 Innovators

HIV infection accounts for 9% of deaths of pregnant women in sub-Saharan Africa (42.5% in South Africa) and substantially hinders progress towards reducing maternal mortality. HIV infection during pregnancy also contributes to poor perinatal health outcomes (stillbirth, preterm birth, low birth weight, HIV infection). Poor uptake and delayed initiation of antiretroviral interventions are the principal determinants of HIV infection of infants and HIV-related maternal deaths.

Women in rural areas lack access to affordable, quality health prevention and treatment services. The absence of health treatment and prevention strategies partnered with harmful local customs discourages positive health outcomes. HealthPartners community-owned, sustainable health coop model empowers local stakeholders to partner for increased access to care and improved health outcomes. This is critical for reducing barriers for pregnant women to seek antenatal care, delivery with a skilled health professional and to receive critical follow up care immediately after birth.

Jhpiego proposes a capacity building and sustaining "Day of Birth" approach to bring lifesaving services to remote health facilities where complications must be prevented and managed simultaneously and swiftly, often by a single provider. This approach uses evidence-based practices in prevention and treatment of the two biggest killers of women and newborns in the hours after birth -PPH and neonatal asphyxia.

Anemia is a persistent global health problem affecting millions of mothers and newborns and contributing to 100,000 maternal and 600,000 newborn deaths annually. Despite massive global investments in nutritional and supplementation programs, continued high prevalence of maternal anemia has unfortunately relegated its status to routine. Jhpiego and the Johns Hopkins University Center for Bioengineering Innovation and Design are developing an innovative method to facilitate the dual goal of community-based screening and national-level anemia surveillance.

Rationale: Gestational Diabetes Mellitus (GDM) is a rapidly growing problem in many developing countries that demands appropriate diagnostic technology. GDM leads to serious complications for both mother and baby, and also predisposes both to developing Type 2 diabetes. Recommended screening for GDM is the Oral Glucose Challenge Test (OGCT). This requires fasting and several hours at the clinic for glucose measurements, leading to low patient compliance. Implementing the OGCT in developing countries has been only moderately successful in pilot studies.

The youngest of babies are the ones most likely to die, often from preventable infections. Handwashing can prevent infections in early childhood. The usual ways to promote handwashing with soap and water are failing - they do not change individuals' behaviors sufficient to impact health. An innovative but low-cost and low-technology solution, chlorhexidine for waterless hand cleansing, could yield dramatic improvements in hand cleansing among mothers and birth attendants, rather than the small changes that typically result from promotion of handwashing with water and soap.

Rationale: Deaths from neonatal sepsis are avoidable. Most occur at home in areas where home delivery rates are high and unhygienic conditions are common. When a newborn has sepsis, death can occur within hours, but parents often refuse to proceed to a hospital and have the child admitted even if transport is provided. A 2007 Consultation of Saving Newborn Lives recommended a simpler regimen that could enable initiation of management (or complete management) closer to the home and increase family acceptance of treatment.