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Senegal has one of the highest mortality rates with 370 maternal deaths per 100,000 live births, and neonatal and infant mortality rates at 47 and 55 per 1,000 respectively. These high mortality rates are due to poor access to health services. To increase demand for and access to quality maternal and neonatal services for women living in hard to reach areas of Senegal, Africare is proposing to develop an innovative model that integrates community based support services (Maternal Care Support Groups/MCSG) with mobile and telemedicine platforms.
Devastating brain injury and neonatal death caused by hyperbilirubinemia (kernicterus) is very common in low resource settings (LRS) but can be prevented by early detection and treatment with light therapy. A major roadblock to the global effort to eliminate kernicterus is the inability to measure total plasma bilirubin (TB) in most LRS, including many referral hospital centers. To meet this need, we are developing an inexpensive POC system that rapidly measures TB. A small drop of blood (ca.
Two hundred and twenty million women worldwide have an unmet need for family planning resources. Although intrauterine devices (IUDs) are effective long-acting contraceptives, IUD insertion is very complex, so IUDs are often unavailable in resource poor settings. Bioceptive's proposal is to create a reusable IUD inserter for the developing world with the goals that it is intuitive, Cu380A IUD compatible, safer, and low cost.
Preeclampsia is a major cause of maternal and neonatal death, particularly in low-income and developing countries. When treated properly the mortality rate is low. Unfortunately many women in low-income countries do not have ready access to proper care. Our research has shown that we can reliably detect preeclampsia 10-12 weeks before the onset of symptoms. We propose to create an inexpensive, easy-to-use, handheld system that detects the likelihood of the future onset of preeclampsia. A 50-patient clinical study will validate its effectiveness.
Urgent shortages of medicines in low-income countries lead to millions of unnecessary deaths at birth every year. One pervasive challenge causing such shortages is how to move the right commodities to the right place on time and at cost. We propose to develop an open-source distribution management system which leverages our existing real-time dataset of stock transactions at thousands of facilities in Africa to drive automated improvements in practice.
The transmission of HIV from mother to child during the birthing process can be largely prevented by the administration of ARV drugs. But, the newborn must start receiving medication within 24 hours after birth to be most effective. In Zambia, only 22.1% of infants born at home to HIV+ mothers receive the medication they need because it is difficult to get the medicine to them.
Reduction of maternal and neonatal death rates in developing countries is far behind the Millennium Development Goals. One method the WHO has recommended to bring down these rates is antenatal vaccination against two life threatening diseases- influenza and tetanus. Unfortunately many countries face bottlenecks for these vaccines because of a shortage in trained health care personnel, and the need for syringes and needles for administration as well as refrigeration for storage.
Guatemala has one of the highest national maternal mortality ratios in Latin America at 149 per 100,000 live births, and up to 260 per 100,000 in some northern departments. Only 31% of deliveries are attended by a skilled birth attendant. Since early 2004 Guatemala has invested heavily in building and updating northern clinics for 24 hour delivery care. It was expected that as access increased, rates of maternal and perinatal mortality would drop. But as of 2012 this had not occurred.
Post-partum hemorrhage (PPH) is a leading killer of pregnant women worldwide. In resource-poor settings, especially in rural areas, many women lack access to quality, assisted delivery by skilled birth attendants, and therefore are at high risk for suffering injury or death consequent to PPH. Uterine balloon tamponade (UBT) has been shown to be an effective technique to treat uterine hemorrhage in developed countries, but has not been widely examined in resource-poor settings.
Globally 814,000 neonatal deaths result from intrapartum birth asphyxia in term babies and 1.03 million from complications of prematurity (WHO/ UNICEF 2010). Effective resuscitation could reduce intrapartum related neonatal deaths by 30%, and deaths from prematurity by 10%, creating potential to save 347,200 babies annually. However, one in five trained healthcare professionals (HCPs) fail to perform the resuscitation technique correctly, and those that do, often experience a rapid decline in proficiency (Patel J et al 2012).
In Rwanda, 90% of all cases of infant and child HIV infections occur through mother-to-child transmission (MTCT). Studies led by Dr. Katherine Luzuriaga demonstrated that early antiretroviral therapy (ART) markedly reduces HIV-related mortality in infants. However, in resource limited settings, the lack of molecular diagnostic methods for early infant diagnosis prevents the timely application of lifesaving HIV therapy.
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries. The majority of these deaths occur outside the health care system, and so an intervention that could be used in any setting and with minimal training could save lives. We will use an animal model to demonstrate appropriate uterine fill, and a proof-of-concept study to show stoppage of post-delivery bleeding and test ease of removal.
Immediate postpartum intrauterine device (PPIUD) insertions (within 10 minutes to 48 hours post-delivery) offer a novel and convenient method to increase contraceptive uptake in developing countries. However, a dedicated PPIUD inserter is currently not available. As a workaround, forceps are used- the IUD is taken out of the traditional interval inserter (used for insertions after four weeks postpartum), and grasped with forceps before it is placed at the uterine fundus. However, sterile forceps may not always be available.
Nearly half of all infant deaths occur in the first 28 days after birth, with intrauterine growth restriction, prematurity, low birth weight, hypothermia, and sepsis as leading causes. Rapid and reliable identification of frail and sick newborns is critical to saving lives. Current algorithms used by community health workers for integrated management of neonatal and child illness can identify up to 50% of frail newborns. However, this leaves 50% undetected even under ideal conditions of worker quality and performance. Improved ability to detect IUGR and frail and sick newborns is needed.
Postpartum hemorrhage (PPH) is the most significant contributor to maternal mortality and morbidity worldwide, disproportionately affecting women in low-resource settings. Most women in these settings deliver without skilled birth attendants, hours away from facilities where skilled birth attendants are available. Injectable oxytocin has been recommended by the World Health Organization for routine use in prevention and treatment of PPH. However, safely delivering an injection requires a trained provider and sterile equipment, ideally in a health facility setting.
Preeclampsia and eclampsia (PE/E) are the second leading causes of maternal deaths and disability in developing countries, affecting thousands of pregnant women and their newborns each year. Magnesium sulfate (MgSO4) is considered the most effective, safe, and low-cost treatment for PE/E. Yet, MgSO4 continues to be greatly underutilized, especially in peripheral facilities, where the majority of women at high-risk deliver.
Vitamin A deficiency (VAD) is a major problem in the developing world that disproportionately affects pregnant women, children, and infants. Vitamin A's role in development and immunity make it critically important to natal/neonatal health. The use of supplements, crops, and grains to reduce VAD has been met with limited success due to issues such as dependency on suppliers, lack of cultural acceptance, high costs, distribution difficulties, and hypervitaminosis. A sustainable, culturally acceptable, and safe way of fighting VAD is needed, particularly in Southern Asia.
In limited-resource settings, morbidity and mortality from preeclampsia results from lack of/delayed diagnosis. Preeclampsia is a hypertensive proteinuric syndrome unique to human pregnancy. The problem is that neither hypertension nor proteinuria is sensitive or specific, especially in women with atypical presentations. We provided novel evidence that the urine of preeclamptic women is highly enriched in misfolded proteins. Based on this, we developed the Congo Red Dot (CRD) as a diagnostic and clinical prognostic tool for preeclampsia.
Pneumonia alone contributes to between 750,000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year world-wide. Provision of oxygen has the potential for large reductions in neonatal and child mortality due to prematurity, birth asphyxia, and other causes. At the level of the small district hospital and sub-district health center there is a major equity issue, as current oxygen provision methods require reliable electricity, which is typically unavailable.
New drug delivery methods for infants are needed in low- and middle-income countries. Each year over three million babies die within the first month after birth, with the risk of death highest during the initial hours and days. Most of these deaths are easily preventable by early administration of drugs or nutrients [WHO/PMNCH "Millennium Development Goal 4" Fact Sheet, 2011]. We propose to develop a low-cost Nipple Shield Delivery System (NSDS) to administer drugs or nutrients to breastfeeding infants via easily disintegrating tablets within a modified nipple shield.
Iron deficiency is a major contributor to maternal death. Improving the health of women through iron fortification of a universally consumed food vehicle will result in significant saving of lives at birth. Tea is universally consumed in South Asia; however iron forms complexes in tea, reducing bioavailability, and thus thwarting earlier fortification attempts. Our approach will make tea viable as an iron fortification vehicle.
Documented incidence of sepsis worldwide is 1.8 million cases annually, and it is increasing in low-income countries and vulnerable populations, such as pregnant women and infants (75,000 maternal/1 million newborn deaths year). Given this devastating scenario it is imperative to seek new strategies based on scientific findings and the application of innovative technologies to minimize the social impact of sepsis. Based on these assumptions, and using science and technological approaches, we propose to develop a rapid, low-cost and effective method for detecting sepsis in early stages.
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