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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+.

Low-Cost Respiratory Support: Reducing Early Neonatal Death in Rural Malawi

Rebecca Richards-KortumRice UniversityHouston, Texas, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

Through a partnership between bioengineers at Rice University, pediatricians at the University of Malawi and Baylor College of Medicine, and industrial design engineers from 3rd Stone Design have designed a novel, rugged bubble Continuous Positive Airway Pressure (bCPAP) system which can be made in small volume at low-cost. This proposal will: (1) rigorously test the efficacy of this device at Queen Elizabeth Central Hospital in Blantyre, Malawi and refine it for use in rural district hospitals; (2) design a complementary training program for nurses and electromedical hospital staff; (3) engineer the bCPAP system for commercial manufacture; and (4) develop a country-wide plan to implement bCPAP at all district hospitals in Malawi. We estimate that on the African continent, where nearly one million babies die each year within a week of birth, the availability of affordable, effective bCPAP could reduce early neonatal mortality rates by as much as 30%.

Scaling-Up of Mobile Technology for Community Health (MOTECH) in Ghana

Karen RomanoGrameen FoundationAccra, Ghana
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

Grameen Foundation, in partnership with Ghana Health Service, aims to expand the successfully piloted MOTECH (Mobile Technology for Community Health) initiative to two new districts in a transition plan towards national scale-up. The program will reach approximately 14,000 pregnant women and 46,000 children under five over the two-year implementation, increasing access to accurate health information, generating increased demand for antenatal, postnatal and neonatal care, and providing detailed data on health service delivery and outcomes to Ghana Health Service. MOTECH has two interrelated mobile applications which focus on improving the health of pregnant women and infants in poor rural areas: Mobile Midwife sends targeted, time-specific, evidence-based voice messages containing important health information to pregnant women and new parents in their local language and the Nurse Application allows community health nurses to electronically record care given to patients so they can easily identify clients in their area due for critical care. If a patient misses scheduled antenatal care, the Mobile Midwife service sends a message to remind the woman to go to the clinic. If she fails to attend, her nurse is alerted via text message enabling the nurse to follow up quickly.

Development of a Low-Cost, Bubble CPAP Kit and Oxygen Blender to Increase Accessibility to Less Invasive Lung Support Equipment for Neonates in Low-Resource Settings

Gene SaxonProgram for Appropriate Technology in Health (PATH)Seattle, Washington, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

Dr. Ashish Jain, of Hindu Rau Hospital in Delhi, India, has developed an improvised bubble CPAP device that relies solely on an oxygen source, water, and parts commonly found in neonatal intensive care units across India. Our proposal aims to further enhance this device by combining it with an innovative oxygen blender that requires neither electricity nor a pressurized source of air and is intended to reduce the hazard associated with providing infants 100 percent oxygen. In addition, Dr. Jain's improvised bubble CPAP device will be tested for compatibility with parts commonly available in India and we will develop procurement and assembly instructions for a bubble CPAP "kit". Finally, an evaluation of human factors will be conducted in India to ensure that the kit, oxygen blender, and instructions meet the needs of health care providers and their infant patients.

ACT for Birth, Uganda (A=audit, C=cell phones, T=technology and training)

Hanifah SegendoSave the Children Federation, IncWestport, Connecticut, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

This proposal involves testing an innovative fetal heart rate monitor powered by human energy (winner of the global INDEX design award) and mobile phone based mortality audit data to improve timely and appropriate action. Uganda's new national paper-based mortality audit system will be adapted to a mobile phone platform to capture maternal and neonatal deaths and stillbirths, and use this data to improve intrapartum monitoring and response. Facilities will collect this data and will be linked to communities using cell phones to request emergency transport and report births and deaths.

From Opposition to Champions of Maternal and Neonatal Health: A Project in Transformational Leadership Amongst Islamic Opinion Leaders in Northern Nigeria

Judith-Ann WalkerDevelopment Research and Projects Centre (dRPC)Kano, Nigeria
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2011

This project confronts the barriers to maternal and neo-natal health constructed and maintained by some community and religious leaders (CRLs) in six states of Nigeria. CRLs provide the ideology, messages and personal life examples which counter the myriad maternal and neonatal health interventions in this region. Previous interventions avoided resistant CRLs, engaging only liberal scholars in one-off events such as workshops. This has failed to bring down the barriers and the death rates persist. This project targets 180 of the most conservative CRLs in 3 states in zone with the highest rates. Using an innovative multi-stage leadership development model, we will train CRLs, support them to attend a study tour in Egypt, facilitate a process by which they use internet and GSM technologies to host community dialogues with Egyptian scholars participating via video link to reinforce correct messages, and convene step-down trainings for lower level CRLs.

Mobilizing Maternal Health in Rural Kenya with E-Vouchers and Information Technology

Samuel AgutuChangamka Microhealth LimitedNairobi, Kenya
Grand Challenges for Development
Saving Lives at Birth
28 Oct 2011

We will administer a system of subsidized pre-paid e-vouchers and transportation subsidies delivered via mobile phone, as well as informational interventions, including SMS messaging, participatory networks, and radio. Our proposal addresses financial constraints by subsidizing the cost of health services, financing the costs of transportation, and providing incentives for women to save money for when they most need it. Our SMS and radio interventions will inform women of the benefits of seeking maternal health services; our Dial a Doctor product will allow women to reach out to providers for advice; and our innovative crowd-sourcing application will allow women to post and get information on the availability and quality of health services in their local area, all with low-tech mobile phones.

PIERS on the Move: Pre-eclampsia Integrated Estimate of Risk Assessment on a Mobile Phone

Mark AnserminoUniversity of British ColumbiaVancouver, British Columbia, Canada
Grand Challenges for Development
Saving Lives at Birth
3 Nov 2011

We will develop a mobile phone application to be used by community health workers in rural, low-resource settings that a) provides local, rapid and accurate risk assessment, referral, and treatment advice for pre-eclampsia, and b) transmits information to referral centers for coordination of triage, transportation and treatment.

Applying Low-Cost Health and Information Technologies at the Community and Clinic Level for Integrated Maternal/Child Health Delivery in Rural India

Amit JainHealthpoint Services India Private LimitedSecunderabad, Telangana, India
Grand Challenges for Development
Saving Lives at Birth
9 Nov 2011

Healthpoint Services India Pvt. Ltd ("eHealthPoint") proposes to deploy maternal/child health services that leverage its existing innovative rural healthcare delivery model while adding cutting-edge mHealth tools to reach out to surrounding communities. The existing model now serves 120,000 people and includes 1) a rapidly-expanding rural clinic network providing both safe drinking water and walk-in primary care on a "for pay" basis that has already achieved operating profitability; 2) village health workers employed by eHealthPoint that have a demonstrated ability to generate demand (> 50% of village households are customers within 3 months); and 3) world class eHealth tools including electronic medical records that span the continuum of care. The project will integrate these existing capabilities with outreach into the surrounding communities, supported by cutting-edge mHealth solutions including smart-phone tools for a) information gathering; b) capturing data from mobile diagnostics that is automatically transmitted to electronic medical records; and c) assisting village health workers in patient education/demand creation.

Prenatal Calcium to Prevent Preeclampsia and Preterm Birth in Resource-Poor Rural Settings: Can a Novel Differential Time-Release Microencapsulated Powder Overcome Barriers to Adherence and Scale-up?

Daniel RothThe Hospital for Sick ChildrenToronto, Ontario, Canada
Grand Challenges for Development
Saving Lives at Birth
15 Nov 2011

We propose to develop a novel once-daily microencapsulated micronutrient powder containing iron, folic acid, and calcium (Prenatal Sprinkles) to overcome barriers to the integration of calcium into prenatal care in developing countries. If successful, our innovation - "differential time-release microencapsulation" - will mask the taste of iron and the gritty tongue-feel of calcium, and facilitate differential iron and calcium absorption.

Islamic Opinion Leaders: Building Capacity for Maternal, Neonatal and Child Health in Northern Nigeria

Yahaya HashimDevelopment Research and Projects Center (dRPC)Kano, Nigeria
Grand Challenges for Development
Saving Lives at Birth
15 Nov 2011

We propose to further empower Islamic scholars to enlighten health providers at service delivery points in 5 resistant communities with low uptake on the correct Islamic precepts on MNCH. This project will contribute to improved health seeking behaviors of men and women of reproductive age; increased uptake of services in primary health facilities; improved capacity of health providers to counter negative perceptions of modern MNCH services; improved immunization coverage; improved uptake of modern family planning methods of the 5 communities. The standard practice amongst development partners in Nigeria is that Islamic Opinion Leaders are engaged in MNCH projects in demand creation role narrowly restricted to changing the opinion, behavior and practices of community members in the Ummah.

Preventing Neural Tube Defects in Nicaragua Through Rice Fortification

Indiana González MoysInstituto de Nutrición de Centro América y Panamá (INCAP)Managua, Guatemala
Grand Challenges for Development
Saving Lives at Birth
15 Nov 2011

This project will prevent neural tube defects in Nicaragua through fortification of rice - a staple food - with folic acid. We will support twelve early adopter rice mills that collectively produce 60% of rice in Nicaragua with training and equipment to enable local production of fortified rice, as well as a comprehensive branding campaign to promote the purchase and consumption of fortified rice. By establishing high consumer demand, high acceptability, and relatively low costs, the program will harvest market forces to drive sustainable production and consumption of fortified rice.

Tampostat: A Low-Cost, Self-Regulating Tamponade for Management of Postpartum Hemorrhage in Low-Resource Settings

Aminur RahmanInternational Centre for Diarrhoeal Disease Research, BangladeshDhaka, Bangladesh
Grand Challenges for Development
Saving Lives at Birth
15 Nov 2011

Tampostat is a self-regulating, low cost, emergency obstetric device designed specifically for use in low-resource settings by greatly increasing safety, efficacy, and ease-of-use over existing condom tamponades. While other condom tamponades take a volume-based approach, which may not account for varying uterus sizes, Tampostat is pressure-based and uses air to eliminate the need for saline. It features a safety valve to prevent over-inflation through auditory feedback and allows for periodic uterine contractions by constantly regulating the pressure. A proprietary probe, which allows a condom to be attached with an airtight seal, aids in guiding the condom into the uterus through guidance. With minimal training, a birth attendant in the field will be able to successfully administer Tampostat for about $1.50 USD.

m-CTG: A Low-Cost Mobile-Phone Cardiotocograph Device for Antenatal and Intrapartum Monitoring to Prevent Perinatal Mortality in Low-Resource Settings

Manoja Kumar DasThe INCLEN Trust InternationalNew Delhi, Delhi, India
Grand Challenges for Development
Saving Lives at Birth
15 Nov 2011

We propose developing a mobile phone based Cardiotocography (CTG) (m-CTG) with inbuilt algorithm and alerts that can be used to identify the at-risk fetuses and monitor high-risk pregnant women for early referral and appropriate action. The proposed cheaper m-CTG device (cost ~$100-120) shall have the functions of standard CTG devices including FHR, fetal movements and uterine contraction. The in-built algorithm shall allow categorization to identify the abnormal ones. This device shall be mobile/ portable and easy to handle. Real-time data transmission by the mobile device shall allow referral and action for high risk cases. Other m-Health applications can be easily integrated for comprehensive and single window continuum service delivery. This shall enforce standardize case management and protocol adherence.

Micro Health Franchise System

Shahid YusafFINCONIslamabad, Pakistan
Grand Challenges for Development
Saving Lives at Birth
18 Nov 2011

Micro Health Franchise System empowers community midwife worker in providing high quality and cost-effective healthcare services to mother and child in poor communities; at their door steps. Micro Health Franchise system also provides entrepreneurial support to the community midwife workers that lead to the standardization of services, access to financial services and having support by an efficient referral network that can respond to emergencies in a proactive manner. At the core of this solution lies the Telehealth module. It is designed keeping in view the advantages of service oriented architecture and provides the Web (Electronic Medical Record), SMS (Short Text Messaging System) and data services (MMS, GPRS) to share and communicate through HL7 standards between community midwife workers and medical specialists at referral center.

Pay it Forward Maternal Health Model

Ken MwendaZoe Alexander LtdNairobi, Kenya
Grand Challenges for Development
Saving Lives at Birth
9 Dec 2011

Malezi-Bora is a mobile application, availed in local languages, with audio content regarding maternal and newborn health. It works on ultra-low-cost handsets and leverages village social networks. It utilizes a pay-it-forward business model, designed to incentivize mothers to virally share its content, and mapping technology to identify mothers in distress. The application focuses on addressing the inability of current health information-sharing systems gaining critical-mass usage and the inability of community health workers to reach every mother. It creates scenarios that ensure that mothers in dispersed villages have access to life-saving information regarding maternal and newborn health. The application leverages village social networks, and provides clear incentives to mothers-to-be, to not only use the content, but also re-distribute it continuously to other mothers-to-be. Its location-mapping technology enables nurses to quickly reach mothers in distress.

Addressing the Fourth Delay: Improving Community-Based Accountability for Maternal and Neonatal Health

Julia SongokMoi University School of MedicineEldoret, Kenya
Grand Challenges for Development
Saving Lives at Birth
14 Dec 2011

We seek to address a critical fourth delay that sustains high rates of maternal and neonatal mortality in western Kenya: the delay in a community's accountability to its mothers and infants. We will develop an innovative information technology that fosters rapid communication and feedback between mothers, their communities, and their healthcare providers: The Mother-Baby Health Network. This information platform will accomplish three primary objectives: (1) Facilitate home and group-based care through Community Health Workers (CHWs) to improve collective advocacy; (2) Provide communities with the capabilities to activate an emergency alert system; and (3) Foster transparency in community and health system responsiveness to maternal and newborn health. CHWs will be equipped to use clinical decision-support on Android phones to correctly triage women and newborns for care. Integrated with SMS messaging, they will be capable of notifying healthcare providers, alerting nearby GPS-tracked Mother-Baby Taxis in an emergency transport system, and activating a personalized community of Mother-Baby Advocates to mobilize local resources.

Building and Sustaining Capacity of Frontline Health Workers in Prevention and Management of Postpartum Hemorrhage and Neonatal Asphyxia on the Day of Birth

Cherrie EvansJhpiego CorporationBaltimore, Maryland, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

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. Our approach will increase the knowledge and skills of frontline health workers, and therefore reduce newborn mortality and PPH in the areas where the intervention is applied through: 1) capacity building of facility teams through targeted training in "Helping Babies Breathe" and "Bleeding After Birth," 2) use of a low-cost, easy to use and durable simulator during training and low-dose high-frequency routine practice sessions carried out at the facilities after training, 3) further reinforcement through supportive supervision via phone and text messages, and 4) awareness creation within the community of improved services at the health facilities to boost desire for facility birth.

Increasing Healthy Behaviors and Use of Reproductive Health Services Through Improved Quality of Care, Novel Incentives, Information Technology, and Enhanced Demand for Health Products

Jill LuotoRAND CorporationSanta Monica, California, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

We propose a comprehensive integrated program to address the comprehensive interrelated factors leading to poor maternal and child health. We combine service delivery improvements with demand-side innovations and multiple mobile phone applications. These include safe delivery kits, insurance for transport and treatment of obstetric emergencies, safe water and hygiene products, and small incentives for women to start antenatal care (ANC) early.

Development and Application of a Point-of-Care Assay for Plasma Bilirubin

Claudio TiribelliBILIMETRIX SRLTrieste, Italy
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

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 Point-of-Care system that rapidly measures TB.

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).

Saving Women's Lives by Simplifying the Treatment for Preeclampsia/Eclampsia with Rectally-Delivered Magnesium Sulfate

Elizabeth Abu-HaydarProgram for Appropriate Technology in Health (PATH)Seattle, Washington, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

We propose to design a gel formulation for sustained release of sulfate (MgSO4) via the rectal route of administration. We will carry out preclinical studies to determine the pharmacokinetics and efficacy of rectal administration of the novel MgSO4 formulation. We will also conduct a user assessment study in Western Kenya among health providers to evaluate the acceptability and feasibility of introducing a rectal delivery method for Preeclampsia and eclampsia. The development of this innovative, non-parenteral delivery system would simplify administration of MgSO4, ensure safe and correct use by providers, and expand access to treatment and prevention of Preeclampsia and eclampsia in rural facilities where it is critically needed.

Sublingual, Heat-Stable Oxytocin Tablets for Postpartum Hemorrhage: A Simple, Rapid, Needle-Free Approach

Manjari LalProgram for Appropriate Technology in Health (PATH)Seattle, Washington, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

Injectable oxytocin has been recommended by the World Health Organization for routine use in prevention and treatment of Postpartum hemorrhage (PPH). However, safely delivering an injection requires a trained provider and sterile equipment, ideally in a health facility setting. Additionally, delivering a lifesaving dose of oxytocin is further complicated by the poor stability of oxytocin - it is inactivated if exposed to high ambient temperatures. We propose to address both challenges by developing heat-stable oxytocin in a fast-dissolving tablet format for sublingual (under tongue) administration. Sublingual tissue is highly permeable and rich in blood supply; it is capable of producing rapid onset of action in blood, which is ideal for the short delivery period required for oxytocin. We will conduct pharmaceutical studies to develop heat-stable oxytocin and conduct preclinical (bioequivalence and bioavailability) studies in pigs to confirm feasibility of the sublingual route (in comparison to standard intramuscular administration). We will confirm heat stability of oxytocin in this format by conducting an elevated temperature stability study. The use of a fast-dissolving tablet format is intuitive and allows for safe, straightforward administration of oxytocin by patient and caregiver. Heat-stable oxytocin in a fast-dissolving tablet format for sublingual administration will significantly reduce maternal deaths from PPH.

Reducing Preeclampsia Morbidity and Mortality in Resource-Limited Settings Through the Urine Congo Red Dot (CRD) Test

Irina BuhimschiThe Research Institute at Nationwide Children's HospitalColumbus, Ohio, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

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. This project takes advantage of our basic science finding (congophilia of preeclamptic urine), translating it in innovative manner toward development of low-cost paper-based diagnostics with potential to decrease maternal and fetal mortality worldwide.

Engineering Lactobacillus casei to Enable Sustainable Home Production of Vitamin A-Enriched Dairy Foods by At-Risk Mothers

Christopher JohnsonUniversity of WisconsinMadison, Wisconsin, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

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. Fermented dairy products, particularly yogurt, are traditionally made by women using small-scale fermentations, often on a per-household basis. In all fermentations, local strains of lactic acid bacteria (LAB) have been utilized for generations as yogurt starter cultures, continuously cultured by a process called back-slopping. We propose to engineer a lactic acid bacteria (LAB), Lactobacillus casei, to produce the provitamin A carotenoid, beta-Carotene. This strain could then be added to local starter cultures, resulting in beta-Carotene-enriched dairy products without any change in production methods. Once this strain is added, it would remain part of the local starter cultures, producing beta-Carotene-enriched products indefinitely. Because these products would contain beta-Carotene and not Vitamin A itself, there would be no risk of hypervitaminosis. This technology, combined with education and outreach, could enable at-risk mothers to provide Vitamin A supplementation for themselves, their family, and even their community in a safe and sustainable way.

Development of a Rectal Antibiotic Formulation for Community-Based Management of Neonatal Sepsis

Nicholas WhiteUniversity of OxfordOxford, United Kingdom
Grand Challenges for Development
Saving Lives at Birth
2 Jul 2013

This project proposes to develop a rectal formulation of a third-generation cephalosporin antibiotic for reducing mortality through early community-based management of neonatal sepsis. It will carry out pharmaceutical and preclinical studies with the aim of developing a stable rectal formulation of a candidate antibiotic with adequate bioavailability. Selection will depend on activity against causative pathogens, a good safety profile, and central nervous system penetration. Rectal administration is a simple, safe, and acceptable method of treating sick children. It would be suitable for the community-based management of neonatal sepsis if an appropriate antibiotic could be provided in a stable and adequately bioavailable formulation which could save millions of infants' lives each year.

Prevention of Maternal Death by Improving Iron Status of Women Through Iron Fortification of Tea

Levente DiosadyUniversity of TorontoToronto, Ontario, Canada
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

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. We will develop spray-encapsulated iron premix that will be attached to tea leaves, and released into hot water during brewing, without altering the tea's sensory attributes. Iron will be encapsulated in enteric coating to prevent formation of non-bioavailable tannin complex in the stomach, the coating will dissolve in the small intestines to expose a high bioavailability self-emulsifying iron delivery system. Our innovations are: (1) the encapsulation/microemulsion approach which protects iron in the stomach and enhances absorption in the lower GI, and (2) using tea as the fortification vehicle which will ease adoption because no user behavior change will be required.

Augmented Infant Resuscitator (AIR)

Data SantorinoMbarara University of Science and TechnologyMbarara, Uganda
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

Effective resuscitation could reduce intrapartum related neonatal deaths by 30%, and deaths from prematurity by 10%, creating the 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. Our Augmented Infant Resuscitator's advanced training capabilities, instant feedback mechanism, and objective self-audit and retraining abilities will maximize and sustain gains from effective resuscitation. The AIR prototype provides instant feedback to users about effective ventilation. This is measured using inexpensive instrumentation that calculates ventilation rate, air volume and air pressure delivered by the bag-valve-mask (BVM) across the resuscitation face-mask. These parameters correlate with the four most common mistakes that result in ineffective resuscitation: 1) Failed seal at the face-mask interface resulting in failure to inflate the lungs; 2) Blocked airways; and 3) Wrong ventilation frequency 4) Insufficient/shallow lung inflation. Each of these mistakes can cause death or brain damage. AIR also records performance on an internal memory card for future feedback, improving HCPs training by identifying persistent gaps in technique.

HIST-BIRTH: Innovative and Rapid Point-of-Care Histone Test Strips for Early Diagnosis of Sepsis in Pregnancy and Childbirth.

Federico Pallardo CalatayudUniversidad de ValenciaValencia, Spain
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

We propose to develop a rapid, low-cost and effective method for detecting sepsis in early stages. We will take advantage of the potential of histones to be sensitive and effective biomarkers for sepsis, and of the versatility, simplicity and low-cost of test strips. The diagnostic test will be simple, comfortable, easy to interpret and low-cost for prognosis/early diagnosis of sepsis based on histone expression. The test can be used by non-technical experts in any hospital or health center worldwide, though it has been designed intentionally for low-resource countries. Proof-of-concept of this diagnostic test will be performed in Uganda, in order to analyze benefits and reduction in mortality of pregnant women and infants in that country. The innovative combination of histones and strips make this diagnostic test a significant improvement over the inefficient methods currently used for sepsis diagnosis, such serum lactate measurement, microbiological sampling, etc.

JustMilk - Development of an Infant Nipple Shield Drug Delivery System Used During Breastfeeding

Nigel SlaterUniversity of CambridgeCambridge, United Kingdom
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

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. A wide-range of active pharmaceutical ingredients (APIs) could be delivered to infants using the NSDS such as antibiotics, antimalarials, antiretrovirals, vitamins, nutrients, and probiotics. Use of the NSDS would empower a breastfeeding mother during the early postnatal period by allowing her to personally administer medicines in a natural setting. This system can provide a novel method for accurately administering drugs and nutrients to breastfeeding infants.

A Low-Cost, Electricity-Free Oxygen Concentrator

Bryn SobottUniversity of MelbourneMelbourne, Victoria, Australia
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

Our proposal will provide this life-saving treatment to isolated, extremely resource poor people by obviating the need for electricity. This will be achieved by applying recently developed hydrological engineering approaches to extract the pressure differential required for the adsorption process exploited by Oxygen concentrators. This project aims to develop and test an electricity free Oxygen concentrator suitable for a developing world health facility. This represents a major paradigm shift, as to-date the problem has been interpreted as how to supply electricity to an Oxygen concentrator. In comparison with solar and generator based approaches the prototype will require significantly less capital cost and maintenance. Further, construction out of locally available components will empower the community to independently and sustainably access this life-saving treatment.

Que Vivan Las Madres: Scaling Up an Integrated Approach to Reduce Maternal and Perinatal Mortality in Northern Guatemala

Edgar KestlerCentro de Investigación Epidemiológica en Salud Sexual y Reproductiva (CIESAR)Guatemala City, Guatemala
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

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. We propose to scale up an already tested innovative strategy, combining technology, service delivery, and demand creation approaches. Our collaborative effort integrates: 1) a low cost, simulation-based training program (PRONTO) using a low-tech birth simulator (PartoPants) to teach provider teams emergency management during childbirth, 2) a research-driven social marketing campaign encouraging women in the target communities to give birth in clinics rather than at home, and 3) professional midwife liaisons charged with connecting traditional birth attendants to the formal health care system. We expect that this effort will catalyze critical practice changes in maternity care, increase the proportion of births attended in clinics, improve maternal outcomes, and decrease perinatal death in indigenous Guatemalan communities.

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