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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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Primary Prevention of Periodontal Disease in Relation to Preterm Birth in Malawi

Kjersti AagaardBaylor College of MedicineHouston, Texas, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

With this proposal, we aim to evaluate the feasibility and acceptability of distribution of chewing gums and/or gummy bear snacks containing at least one polyol on the primary prevention of periodontal disease in association with PTB and SGA births through the rural expansion of our current established community-based health care efforts in Lilongwe, Malawi.

Low-Cost, Point-of-Care Paper-Based Microfluidic Diagnostics for Improving the Identification and Treatment of High-Risk Pregnancies in Resource-Limited Rural Settings

Patrick BeattieDiagnostics For AllCambridge, Massachusetts, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

To improve rural health care for expecting mothers and newborns, Diagnostics For All (DFA) proposes to develop two accurate, low-cost (<$0.10) postage stamp-sized paper-based diagnostics for expecting mothers and newborns that will be used to detect - and enable proper treatment of - (i) anemia and hyper/hypoglycemia and (ii) hypertensive disorders. These point-of-care diagnostics require only a drop of blood or urine and require no additional steps beyond applying the sample. This means that they can be utilized by minimally-trained individuals in communities or clinics in rural settings to prevent unnecessary deaths during pregnancy and childbirth and improve the health of mothers and newborns through early detection of high-risk pregnancies and better patient management.

Reducing Fetal and Maternal Mortality in Developing Countries Through Simulation-Based Training for Emergency Cesarean Section

Robert BuckmanOperative Experience, Inc.Elkton, Maryland, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

Operative Experience, Inc. has pioneered unique, simulation-based methods to teach major surgical operations and currently trains military physicians and combat medics in critical trauma procedures. We propose to utilize our methods to teach healthcare providers in underserved areas to perform emergency cesarean sections. Our system is based on video demonstration of operative procedures using physical models of unprecedented anatomical and surgical accuracy. The models consist of artificial tissues that can be cut, dissected, retracted and sutured using standard surgical instruments. The trainee practices the operation on the simulator with a mentor until proficient in the techniques of the procedure.

Sustainable Access to Maternal/Newborn Services: A Market Approach

Maja CholodyPartners for DevelopmentSilver Spring, Maryland, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

Partners for Development (PFD) will develop an innovative model to ensure access to ante/postnatal and delivery care (ANC/PNC) in 25 underserved villages in northeastern Cambodia: a transportation system of private sector providers in partnership with local government. To increase demand for such transport and make the system financially sustainable, routes will include schools, markets and other popular destinations in addition to health facilities. Costs will be affordable to consumers and prices adequate for providers via set monthly amounts paid to the providers. In exchange for the monthly payment by the village, the private providers will agree to create affordable transport rates for users. Each village's cost contribution will be calculated according to the distance from its borders to the next stop on the route, reducing the otherwise high cost to the furthermost areas. Families will pay a monthly rate to its respective Village Development Council for unlimited trips, removing what is otherwise a financial disincentive to preventive care. The VDC will then pay each transporter, guaranteeing 24-hour availability. Revolving village loan funds can provide for emergency travel. Villages will: determine optimal routing; establish household fees; set loan interest rates/repayment terms; and determine how to publicize the system. PFD will measure success by: changes in ANC/PNC delivery service utilization; household subscription rates; and transporter profits. The model has replication potential globally.

E-Partogram

Shoval DekelJhpiego CorporationBaltimore, Maryland, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

Jhpiego and its partners (Johns Hopkins University Center for Bioengineering Innovation and Design and Laerdal Global Health) propose to rapidly develop and conduct initial field-testing for an "E-Partogram", an affordable, easy-to-use, handheld electronic decision-making tool for preventing or managing complications during labor. The E-partogram could positively transform safe childbirth by enabling front-line providers to more rapidly assess and respond to labor complications and receive crucial guidance to save the lives of women and newborns.

Baby Monitor: Connecting Women and Infants to Care in Rural Settings Through Remote IVRS Screenings with New and Expectant Mothers

Eric GreenPopulation CouncilNew York, New York, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

Baby Monitor, a mobile interactive voice response system, will bring clinical assessment and referrals directly to mothers and their infants in resource-poor settings who are unlikely to access routine care. To date, mobile applications largely have been used to send patient reminders and health information or to collect patient information through intermediaries such as community health workers. Patients in developing countries have not been end-users of mobile diagnostic tools and medical record systems. If successful, this innovation could save lives, improve health outcomes, and optimize the use of extension workers in rural and remote regions where access to health systems is limited and clinical assessment often occurs too late or not at all. Baby Monitor will help mothers to assess the signs and symptoms of newborn and maternal ill-health in the weeks before and after birth. The system will assess responses to verbal screening questions, provide mothers with health information, and, when necessary, make referrals, alert healthcare providers, and dispatch appropriate healthcare workers.

Better Cord Care Saves Babies' Lives in Nepal

Leela KhanalJSIKathmandu, Nepal
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

In Nepal, despite recent efforts to increase deliveries attended by a skilled provider, fewer than 20 percent are reached with such care. Much of the population faces significant geographic barriers to care, and a large proportion of newborns are exposed to poor hygiene conditions over their first few days of life. Nearly 70 percent of infant deaths occur within the first month of life, the most common cause being infection. A trial in Nepal has shown that risk of death can be reduced by 24 percent with application of the antiseptic chlorhexidine (CHX) to the umbilical cord stump. In four pilot districts, JSI has tested and successfully shown a multi-channel distribution approach, relying primarily on a nationwide cadre of female community health volunteers (FCHV) who already provide other antenatal care (ANC) support. JSI proposes scaling up these approaches as a realistic strategy to rapidly and sustainably achieve high coverage of CHX application to the newborn cord stump, nationwide.

Feasibility and Safety of a New Simple and Low-Cost Device (Odon Device) for Assisted Vaginal Delivery

Frederik KristensenWorld Health OrganizationGeneva, Switzerland
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

The specific aim of the proposed study is to test the safety and feasibility of a new low-cost device (Odon Device: http://www.youtube.com/watch?v=OGLLXFzULd4) to deliver the fetus during the second stage of labor. This device may be potentially safer and easier to apply than forceps/vacuum extractor for assisted deliveries, and a safe alternative to some Caesarean sections in settings with limited surgical capacity and human resource constraints. It has potential for wide application in resource poor settings even by mid-level providers. If proven safe and effective, the Odon Device will be the first innovation in operative vaginal delivery since the development of forceps centuries ago and vacuum extractor decades ago.

A Simple, Rapid Assessment Tool to Identify and Triage Preterm Infants

Anne LeeJohns Hopkins UniversityBaltimore, Maryland, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

Preterm birth leads to more annual neonatal deaths (1 million) than any other single cause; these deaths primarily occur in low income settings where many infants are born at home and gestational age is rarely assessed. Innovative ways to identify preterm infants in the community are needed to facilitate rapid and appropriate targeting of interventions and referral. Newborn clinical assessment by medically trained personnel allows accurate estimation of gestational age, but methods are complex and simplified methods have not been developed and validated for use by community health workers (CHWs). We have developed a simple, color-coded pictorial scorecard intended for use by CHWs to identify early preterm (<34 weeks=red zone) and late preterm (34-37 weeks= yellow zone) infants. Validation of this simple tool for use by CHWs may help reduce the large burden of newborn deaths related to prematurity.

Anti-retroviral Pouch for the Prevention of Transmission of HIV from Mother to Child During Home Birth

Robert MalkinDuke UniversityDurham, North Carolina, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

An HIV+ mother will often be reluctant to travel to a clinic the day or two after delivering her baby. She may feel too weak to travel to a clinic miles away or fear stigmatization after explaining why she must go to a clinic after delivering a healthy baby. This leaves millions of children at risk of becoming HIV+ during the birthing process. We have developed and tested in the laboratory a foilized, polyethylene pouch - something like a fast-food ketchup pouch - that can store the medication for months. If the mother is unable to make it to the hospital to deliver, she can tear open the pouch and provide the drugs to the infant, preventing her newborn from becoming HIV+.

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