2012 Innovators

Rationale: Cambodia's maternal and neonatal mortality rates remain unacceptably high. Only 54% of mothers deliver in a facility, and increasing utilization of health centers is central to the government's strategy.

Catholic Relief Services, in collaboration with local implementation partners the Nicaragua Ministry of Health (MoH) and Caritas Matagalpa, and supported by researchers at John Hopkins Bloomberg School of Public Health and the Sustainable Sciences Institute, proposes to scale up a proven integrated solution that optimizes birth outcomes in the poorest and most remote communities of Matagalpa, Nicaragua where high maternal and neonatal mortality continues to be a critical problem.

Most rural health facilities in Uganda and many parts of Africa have no electricity, lighting or phones to communicate with clients or doctors, which contributes to low uptake of antenatal and maternity services and unsafe care for pregnant women who deliver there. Power for Life (PFH) will conduct a case-control study in 12 rural health centers in 2 districts of Uganda to test the idea that: a) supplying solar power and lighting, and b) providing data and voice technology will improve health seeking behavior, quality of care during childbirth, and birth outcomes.

Lao PDR is well short of the 2015 targets for MDGs 4 and 5. It has one of the highest Maternal and Infant Mortality ratios in the Western Pacific Region. Furthermore the levels of maternal and infant morbidity, especially from pneumonia and other respiratory infections, are very high. A key likely contributor to post-parity maternal and infant deaths and morbidity is exposure, for both mothers and infants, to extreme heat and smoke pollution during the yu fai process (mother roasting) which is practiced by over 90% of Lao families for up to 45 days after birth.

Low birth weight (LBW) infants are at higher risk of hypothermia due to their increased surface-to-mass ratios; studies indicate that the prevention and management of hypothermia through thermoregulation can reduce neonatal mortalities by up to 42%. Roughly 500 district hospitals in Vietnam lack neonatal intensive care units, forcing them to transfer infants with pathologies to provincial hospitals. Transport is unsophisticated and lacks standardization; ambulances, when available, are not equipped to provide thermoregulation. Transport is the weak link in the warm chain.

Nearly half of all infant deaths occur in the first 28 days after birth, with prematurity and low birth weight as leading causes. We propose to assess the feasibility of development and distribution of an indigenous energy protein supplement to at-risk pregnant women attending health centers in rural Gujarat to reduce infant intrauterine growth retardation and monitor key biological parameters of their at-risk infants through a low cost mobile device.

This proposal outlines a model for demonstrating whether a Conditional Cash Transfer Scheme (CCTS), integrated into a larger program effort, can increase demand for and utilization of maternal and neonatal health (MNH) services in rural Zambia, where health indicators remain stubbornly dire. The model is based on evidence suggesting that current demand-side interventions, including increasing knowledge of danger signs and raising awareness of available services will not be sufficient to overcome the barriers necessary to bring utilization in line with clinical need.

The world is facing a shortage of 4.3 million health workers, with every region except Europe showing a shortfall. Rapid urbanization in developing countries is exacerbating shortage of health workers in rural areas, as trained professionals seek work in more affluent urban conurbations.

Maternal and child health in poor countries suffers from failures in supply and demand. Health workers face weak incentives to provide quality services, while patients under-utilize what health services do exist, due to cost, lack of information, and perceived low quality of services. We propose to conduct an investigation of two innovative, social accountability interventions that aim to address these shortcomings by incentivizing health workers and stimulating demand for health services.

In Bangladesh, 77% of births occur outside a facility and 72% without a skilled attendant. When maternal or neonatal complications occur, <40% of women seek care, mainly due to misunderstanding of complication severity and/or necessity for referral; relatives or neighbours are the primary referral sources. Antenatal care coverage and logistical preparation for childbirth emergencies are also poor. An intervention to empower mothers and layperson referral gatekeepers to overcome these logistical, knowledge, communication gaps is urgently needed.

Ten years after the ouster of the Taliban, Afghanistan's maternal mortality rates are still among the world's highest, accounting for over five percent of all annual maternal deaths across the globe. Neonatal mortality is equally abysmal, and fragile gains in the sector remain hindered by severe coverage and access gaps arising from structural capacity constraints and a dearth of skilled midwives providing basic health education to expectant mothers in isolated rural areas. Gender repression and cultural perceptions pose additional challenges.

Jacaranda Health has a dual mission of providing affordable, high quality maternity services to low-income women whilst being a laboratory for integrating innovations for maternal health. We are a chain of maternity clinics in Kenya that provide deliveries, antenatal and postnatal care, and family planning.

This project expands a 5 year Kybele-Ghana Health Service partnership analyzing systems and patient care processes at Ridge Hospital, a large obstetric referral center in Accra. The partnership addressed leadership, motivation, knowledge deficits, equipment shortage, patient flow and communication problems yielding a 34% decrease in maternal mortality and a 36% decrease in stillbirth, despite a 36% increase in patient admission with higher disease acuity.

Rationale: Severe neonatal jaundice (hyperbilirubinemia) can be treated by exposing an affected newborn to intense blue light. However, babies diagnosed with jaundice are often placed under phototherapy lights that are ineffective, old or poorly maintained. Inexpensive solutions for predictive maintenance of such technologies are needed to assess the quality of treatment and provide data for long-term equipment management.

In this decade, maternal and reproductive health voucher programs have contributed to reduced maternal and infant mortality and morbidity. The Uganda program is considered a key success. The administrative cost of supporting these safe births is approximately 32% of total program costs. 

Neonatal infections are estimated to account for over one million newborn deaths annually, almost half of which happen in Africa. Community-based trials in Asia applying a 4% chlorhexidine (4% CHX) to the umbilical cord showed reduction in newborn death by 23% and a three-quarters reduction in serious umbilical infections. Effectiveness trials to generate evidence in Africa are underway in Tanzania and Zambia and are expected to be completed in 2014.

Globally, newborn sepsis is the cause of over 500,000 of the 3.1 million newborn deaths each year. Applying a 4% chlorhexidine product (7.1% chlorhexidine digluconate) to the umbilical cord saves newborn lives and is a cost-effective intervention. Data from Bangladesh, Nepal, and Pakistan demonstrated an aggregate 23% reduction in neonatal mortality (not including deaths in the first few hours of life) and a 68% reduction in severe infections for the chlorhexidine intervention groups.

Rationale: Newborns are vulnerable and have high mortality in low income countries. BCG vaccine is known to stimulate the immune system and its early administration can modulate how the child copes with other infections. In randomised trials of BCG-at-birth to low-birth-weight (LBW) children, we have shown that BCG is associated with 40-50% lower neonatal mortality, the effect being due to less neonatal sepsis and respiratory infections. The beneficial effect has been observed already within the first three days.

Rationale: Decrease maternal and newborn morbidity and mortality at childbirth in poor hard-to-reach populations.

This project will address the problem of high maternal and neonatal deaths in rural South Sudan as a result of multiple barriers left after years of civil war: traditional birth attendants (TBAs) and staff of rural government health clinics have inadequate training and resources to assess and manage pregnant women appropriately; there is lack of trust in and familiarity with these persons by pregnant women; and most homes are at remote distances from health clinics over undeveloped roads.

In poor communities, Participatory Women's Groups (PWGs) that focus on maternal and newborn health can dramatically reduce newborn deaths and catalyze improvements in the demand, delivery and quality of maternity services. Trials in Nepal, India, Malawi and Bangladesh showed that engaging PWGs in participatory learning and action reduced newborn deaths by up to one third. Coverage is important. In Bangladesh, with one group per 1500 population, newborn mortality fell by 7%; when scaled to 1 group in 300, mortality fell by 34%.

Cephalopelvic disproportion (CPD) is the primary mechanism of obstructed labor, one of the five major causes of maternal mortality globally. A term literally translating to the mismatch between the fetal skull and woman's pelvis, this condition is most felt by women who, because of poor nutrition, young age of motherhood, and/or bone-affecting disease, have an improperly developed pelvis that is unsuitable for childbirth.

The problem is lack of skilled/equipped Traditional Birth Attendants(TBAs) with financial resources to provide quality care during birth in hard-to-reach communities in Imo State Nigeria. TBAs are unskilled and their maternity homes lack electricity, clean water and proper equipment to conduct evidence based practices. TBAs are usually unbanked, financially excluded which limits their access to credit.

Rationale: Maternal and newborn mortality and morbidity are high in Afghanistan. Rates of antenatal care, skilled attendant at birth and postpartum care are low. The Afghan Mortality Survey 2010 found that the reasons for not using health services often related of not understanding the need for care. Therefore the links between communities and health providers and facilities need to be strengthened.