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.

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.

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+.

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.

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.

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.

This project will involve the development of a novel aerosol delivery system for oxytocin that can be inhaled by patients from a simple, disposable device immediately after childbirth. This approach will remove the need for sterile conditions and trained health workers for administration of oxytocin. It will eliminate the risk of needle-stick injuries, transmission of blood-borne viruses and the costs associated with disposal of sharps and biohazard waste materials, as well as provide a more stable formulation of the drug that does not require cold-chain storage. This project will lead to increased access to proven evidence-based strategies for the prevention and treatment of post-partum hemorrhage for women in remote, rural communities. The product will be low-cost and have an immediate, substantial impact on maternal mortality and is not dependent on material resources, electricity, clean water or transportation to hospitals.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.