Maternal, Newborn, and Adolescent Health

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.