Finalists

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.

Each year millions of births, including those in facilities, occur without effective monitoring or appropriate response. The baby’s heart rate is the most important signal of distress in labor. Inadequate heart rate monitoring and failure to respond to distress is an important determinant of almost 1 million newborn deaths and 1.2 million stillbirths each year globally. Effective monitoring during labor in challenging settings depends on rugged, reliable, simple devices able to be used without electricity or batteries.

There is an urgent need for low-cost, easy-to-use tools that can accurately predict adverse outcomes associated with pre-eclampsia (a major cause of maternal and perinatal mortality).

Over 24 months with $250,000 in seed funding 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.

Does hand washing with soap and water or alcohol-based hand sanitizers address the well-documented need for clean birth practices? Clean birth practices, including hand hygiene of birth attendants and use of clean or disinfected instruments to cut and tie an umbilical cord, are of critical importance. Evidence suggests that hand hygiene practices among birth attendants and disinfection of birthing equipment and surfaces are not always optimal. Often water and soap or alcohol-based hand rubs are not available.

Drugs are available to prevent bleeding after giving birth (postpartum haemorrhage). However, current products are poorly suited to transportation, storage or administration in resource-poor countries. The drug of choice for treatment of postpartum haemorrhage is oxytocin, which is given via injection. This presents complications in developing countries, where it is often not possible to provide sterile equipment, clean water or trained medical personnel during childbirth.

Problem: Hypertensive diseases of pregnancy (HDP) and preterm birth (PB) are major causes of maternal and newborn death, particularly in rural settings where access to emergency obstetric and neonatal care is limited.

Challenge: Prenatal calcium supplementation is a simple, low-cost intervention that could reduce maternal HDP-related mortality by 20% and PB by 24%.

Neonatal sepsis is the single greatest cause of preventable death in children living in tropical countries. Most deaths occur in or near home. Prompt parenteral administration of effective antibiotics is life saving, but seldom possible in the rural tropics. We propose to develop a rectal formulation of a third generation cephalosporin antibiotic for reducing mortality through early community-based management of neonatal sepsis.

 Almost two-thirds of neonatal deaths, and a high proportion of maternal deaths, occur within the first 7 days after delivery. It is often assumed that patients can recognize severe complications, when to seek care, and feel empowered to do so. Very often; however, this is not the case. During this high-risk period immediately after birth, mothers are often at home with no monitoring from skilled providers. Mothers can be unsure of whether certain symptoms are normal and, more importantly, often are not empowered to seek care even when experiencing a severe complication.

A recent UNICEF report states:  Pneumonia kills more children than any other disease  more then AIDS, malaria, and measles combined. Our focus is on the introduction of new technology that will make available proven and newly emerging treatments for a variety of respiratory disorders affecting infants in low resource settings.

Our approach is based on providing respiratory support with inhaled nitric oxide (NO). Nitric oxide was considered to be a highly toxic pollutant as recently as the 1980s.

Most women in rural Mali give birth at home and with limited assistance, due to unmanageable distances between communities and health facilities, unsupported community health workers and the inability of the health system to track pregnant women and respond to high risk and emergency cases. As a result, Mali has one of the highest maternal mortality rates in the world.

In a non-traditional partnership between non-profit and private sector, Catholic Relief Services is joining with technology innovator Dimagi and training leader Hesperian Foundation to improve maternal well-being and reduce newborn death by up to 50% in Uttar Pradesh, India.

Blood transfusions in the countries of sub-Saharan Africa and Southeast Asia are critically important. The low standard of living and malnutrition in these countries leads to high frequency of anemia, particularly in children and women. According to World Health Organization (WHO) 30 to 40% of women in sub-Saharan Africa have anemia and about 25% of postpartum deaths in women are related to obstetrical hemorrhages. While blood transfusions are essential, blood safety remains a major problem in the developing world.

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.

OXYVITA Inc. has developed a powder form of its transfusible hemoglobin based oxygen carrier. This product has undergone initial testing in an animal hemorrhage model with success, making the product the first powder form of a red blood cell transfusion alternative in the world. In third world settings where the greatest percentage of maternal hemorrhage death occurs, ease of administration of the product is vital. Currently, our product is designed for use in a hospital setting, however, its real benefit is that it can be used in remote locations, injected on site by a medic or midwife.

Grameen Foundation, in partnership with Ghana Health Service, is requesting support 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.

A major gap exists between what is known – the evidence base for effective maternal and neonatal health (MNH) – and what is practiced, especially in low- and middle-income countries. Interventions that can effectively close this gap in these settings depend on community engagement, reliable health systems, and effective leadership. Over the past four years, the Malawian NGO, MaiKhanda, has tested ways to improve health system effectiveness for MNH.

Optimal care during childbirth in rural areas of most low and middle income countries is hampered by 2 major problems: the limited equipment and capacity of health workers for diagnosis, and the quasi-absence of back-up from the hospital, which impacts on their motivation and competence.

Low-resource environments present many challenges for maternal and neonatal healthcare delivery. Among these, is a lack of basic equipment to preserve and protect newborns, particularly at-risk neonates. For example, a simple incubator/warmer is lacking in most primary health care facilities. Devices to provide respiratory support are also lacking. Furthermore, available solutions pioneered by developed countries do not fare well in a resource limited area- for example, reliable electricity supply is not readily available.

Containers 2 Clinics (C2C), in partnership with The Synergos Institute and the Namibia Ministry of Health and Social Services (NMoHSS) will pilot a regional cluster of three state-of-the-art shipping container healthcare clinics, and provide comprehensive services, including clinical, lab, pharmacy and programming for women and children.

Medical doctors and registered nurses who work with birthing mothers in rural, developing countries have had their hands tied for too long; they need better monitoring equipment and the education to use that equipment to generate data that will allow them to more effectively treat expectant mothers. The Bolivia Delivers project proposes to develop a low cost, portable maternal and fetal monitoring system that will allow rural practitioners to make decisions based on trends that occur over time in their patients’ physiological data.

Women’s health in India is neglected because the public health system is not functioning properly. A recent study found that nearly 40 percent of health staff in India are absent from work on a typical day; and it gets worse in rural areas. This problem negatively affects both the way women use health facilities and their health outcomes: Only 18 percent of births take place in a public facility, and the neonatal mortality rate in India is almost 40 percent.

Each year worldwide, millions of preterm infants (born before 37 weeks gestation) are born, many with lung immaturity that leads to respiratory distress syndrome, a major cause of morbidity and mortality. In the developed world, infants such as these are supported with continuous positive airway pressure (CPAP) devices, obviating the need for mechanical ventilation, which requires placement of a tube in the trachea that can cause lasting damage to the airways.

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.

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.

The persistence of mortality and severe morbidity from pre-eclampsia and eclampsia (PE/E) demands a new approach. Jhpiego—in a growing collaboration with Johns Hopkins University Center for Biomedical Innovation and Design (JHU-CBID), Laerdal Global Health, and other manufacturers—is making available new technologies and offering selected interventions through a new community-centered platform to reduce PE/E, the second leading cause of maternal mortality (after hemorrhage) worldwide.

The statistics are clear. Over one third of all maternal mortality in the developing world results from hemorrhage. Compounding this problem and contributing significantly to the death rate are very difficult transportation logistics from remote rural regions to key national medical centers, and endemic anemia in the female population.

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.

Each year in sub-Saharan Africa 880,000 babies are stillborn and 1 million die in the first week of life. Many of these deaths are due to maternal infection with HIV, syphilis or malaria, or to maternal anaemia, which cause stillbirth, preterm birth and low birth weight, increasing the risk of neonatal death. In rural Tanzania, as in many other African countries, more than 80% of pregnant women attend antenatal clinic, but few are screened and treated for these conditions – an important missed opportunity to save newborn lives.

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.

Complications due to prolonged second stage of labor include potentially fatal maternal (hemorrhage, infection) and newborn complications (birth asphyxia and trauma).