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.

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.

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 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.

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 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.

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.

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.

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.

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.

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.

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.

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.

We propose to design a gel formulation for sustained release of sulfate (M_gSO₄) via the rectal route of administration. We will carry out preclinical studies to determine the pharmacokinetics and efficacy of rectal administration of the novel M_gSO₄ 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 M_gSO₄, 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.

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.

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.

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.

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.