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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

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An Intuitive Multi-Use Intrauterine Device (IUD) Inserter to Expand Access to Contraceptives and Family Planning in Resource-Poor Settings

Suchi KuhranaBioceptive, Inc.New Orleans, Louisiana, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

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. Bioceptive will develop a reusable version of its patent-pending IUD inserter that makes the insertion procedure easier and safer, allowing more women worldwide to take advantage of one of the most effective forms of contraception. The design of this reusable inserter will be based on Bioceptive's disposable inserter, which is prohibitively expensive for use in the developing world. The reusable inserter will expand access to the most common type of intrauterine contraceptive device to millions of women at low cost. Bioceptive's IUD inserter will eliminate the need to use four separate instruments for IUD insertion, making the procedure simpler, safer and intuitive. Bioceptive's inserter replaces these other instruments with one intuitive device, allowing any healthcare worker to insert an IUD with minimal training, even in resource-poor settings. This will have a major impact on maternal health by addressing a major gap in access to IUDs, a most effective contraceptive option.

Inexpensive, Hand-Held Early Warning and Detection System for Preeclampsia

Neil EuilanoConvergent Engineering Inc.Newberry, Florida, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

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. Pregnant women can be scanned non-invasively and extremely inexpensively (no disposables required) in 5-10 minutes.

CommTrack: A Distribution Management System to Serve the Last Mile

Kara GrijalvaDimagi Software Innovations Private LimitedNew Delhi, Delhi, India
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

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. Specifically, we will make optimal usage of limited resources to improve route planning and scheduling, respond to delivery or cold chain failures, strengthen communication, and reduce inappropriate resource utilization. These tools could save governments hundreds of thousands in the cost of fuel, trucks, drivers, and wasted/lost stock, while also improving reliable access to better quality, life-saving commodities.

Healthcare System Integration of the Pratt Pouch for the Prevention of Transmission of HIV from Mother to Child

Robert MalkinDuke UniversityDurham, North Carolina, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

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. In our first round of seed funding, we have shown that the Pratt Pouch, a foilized, polyethylene pouch - something like a fast-food ketchup pouch - can store antiretroviral medication for a year, that African pharmacists and pharmacy technicians can accurately fill and seal the pouch, and that HIV+ mothers can open and accurately administer the pouches in a controlled, clinical setting. With our novel solution, if the mother is unable or unwilling to travel to the hospital to deliver, she can tear open the pouch and provide the drugs to her infant, preventing the newborn from becoming HIV+. In this new study, we will train PMTCT healthcare workers and lay counselors in five remote health facilities in the district of Siavonga in Zambia. Our objective is to integrate the pouch into the healthcare system such that every HIV+ mother at risk of giving birth at home during the study period, and served by the five clinics under observation, receives the pouch. Ultimately, we will show that the Pratt Pouch can increase the percentage of infants born at home to HIV+ mothers receiving ARVs.

Co-Administration of Influenza and Tetanus Toxoid Vaccines to Pregnant Mothers Using a Simple-to-Administer, Thermostable Microneedle Patch that Generates No Sharps Waste

Ioanna SkountzouEmory UniversityAtlanta, Georgia, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

To increase vaccination coverage, we propose to develop a microneedle patch that co-administers the influenza and tetanus toxoid vaccines. Our approach is specifically designed to meet the needs of pregnant women and children under the age of 5 in developing countries by (i) seeking to prevent tetanus and influenza infection (ii) co-administering both vaccines with a simple-to-apply, thermostable patch that generates no sharps waste, thus improving safety by avoiding hypodermic needles. This type of vaccine administration requires minimally trained personnel, and is painless and therefore more acceptable to those being vaccinated. Additionally, because the vaccine patches are dry and do not need reconstitution they have improved thermal stability, and so can be shipped to remote areas and stored for prolonged periods without refrigeration.

Scaling Up Uterine Balloon Tamponade System for Postpartum Hemorrhage in Kenya and South Sudan

Thomas BurkeMassachusetts General HospitalBoston, Massachusetts, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

We propose to roll out and evaluate a next-generation uterine balloon tamponade (UBT) device to arrest maternal hemorrhage in Kenya and Sierra Leone, where maternal mortality statistics are alarmingly high. We will deploy UBT as part of a best-evidence package of training, commodities, and checklists related to the treatment of PPH. We have established strong proof of concept for our package in these countries. The UBT system will also include cutting-edge cell phone technology that will facilitate UBT referral tracking and documentation of patient outcomes.

Nanobiosym Pilot: Optimization and Evaluation of Gene-RADAR Nanotech Platform Point-of-Care HIV Diagnostic Device Prevention of Mother-to-Child Transmission in Rwanda

Anita GoelNanobiosym, IncCambridge, Massachusetts, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

The Nanobiosym Gene-RADAR nanotechnology platform enables rapid, accurate, mobile, gold-standard viral load monitoring at the point-of-care at an affordable cost. In collaboration with Partners in Health in Rwanda, Nanobiosym will deliver, pilot, and evaluate Gene-RADAR, to provide early detection of HIV and demonstrate the eradication of mother-to-child transmission (MTCT) through its mobile health applications. In combination with timely antiretroviral therapy (ART) this platform could save thousands of young Rwandan lives. Nanobiosym's Gene-RADAR nanodiagnostic enables real-time analysis of genetic fingerprints contained in a drop of blood or saliva, as well as the first-of-its-kind capability to quantify the HIV viral load in a field setting at an affordable price. Its ability to measure viral load during gestation, delivery, and post-partum in mothers and infants will enable earlier detection and customization of ART in real time, eliminating the need for costly and resource intensive lab infrastructure. By calibrating ART and routinely monitoring viral load, Gene-RADAR will enable doctors in the developing world to screen, customize, and adjust the dosing regimen for maximum impact on MTCT.

A Novel Agent for Management of Postpartum Hemorrhage: Adaptation of the Xstat Mini-Sponge Applicator for Obstetric Use

Maria RodriguezOregon Health and Science UniversityPortland, Oregon, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

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. Standard care for treating PPH consists of massage, uterotonics, and tamponade (i.e., "holding pressure"). Devices used to treat PPH via tamponade are not easily adaptable to low-resource settings with diverse climates and providers. A novel agent, the XSTAT mini sponge dressing, has proven successful in the acute cessation of traumatic non-compressible bleeding analogous to PPH. This device utilizes pre-packaged, environmentally stable, compressed medical sponges soaked with a hemostatic agent and administered by a light-weight applicator. The sponges, once deployed, exert uniform pressure to address multiple sources of bleeding and are easily removable.

Postpartum Intrauterine Device Inserters

Sara BreulPopulation Services InternationalWashington, District of Columbia, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

Population Services International (PSI) proposes to conduct a proof-of-concept study followed by a larger clinical trial in two public sector hospitals through FOGSI in India, to determine if a new intrauterine device (IUD) inserter, specifically designed for the postpartum setting, will improve service delivery. Pregna International will provide the inserters free of cost, and Stanford University will provide technical expertise in study design and implementation. The primary objective of the study is to determine the safety, acceptability (provider/consumer comfort and confidence), feasibility, and efficacy of postpartum intrauterine device (PPIUD) inserters.

Rapid Diagnosis of Frail and Sick Newborns with a Handheld Vital Sign Monitor

Anuraj ShankarPresident and Fellows of Harvard CollegeCambridge, Massachusetts, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

We have designed a low-cost, hand-held, non-contact, point-and-click vital sign monitor (VSM) for neonates that assesses heart and respiratory function, PO2 saturation, thermal regulation and blood vessel branching to improve detection and referral of frail newborns. The VSM can be used by community health workers (CHW) and clinic-based personnel. We propose to assess the potential of the VSM as a tool to save newborn lives. This will compare VSM-based identification of frail infants with conventional clinical assessment, and in a community setting it will compare the ability of the VSM to enhance CHW impact on newborn health and survival with current practice of CHW monitoring of birth weight and Integrated Management of Neonatal and Childhood Illness (IMNCI).

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