Addressing Critical Knowledge Gaps in Newborn Health

Great expectations from grand challenges: Calling for technological innovation to speed up saving the lives of mothers and newborns

Wind-up powered devices for where there is unreliable electricity, needle-free injections, or inhaled instead. We need more innovation specifically to address the rich-poor gap for medical equipment. An Argentinian car mechanic, inspired by a party trick extracting a cork from a bottle, developed a low cost device to save babies and women from obstructed labor. The Odon device, a plastic bag that is inflated and fixes around the baby’s head to assist during complications due to prolonged second stage of labor, has the potential for wide application in low-resource settings. Across the world, a Norwegian business entrepreneur, has advanced efforts to save babies who do not breathe at birth with a simpler, upright neonatal resuscitation device and lower-cost training mannequins. We need more ideas and more thought leaders like these!

Three-quarters of the world’s births and most of the world’s newborn deaths happen where there is little or no access to devices that can make the difference between life and death. For example, most of the world’s preterm babies have no access to oxygen therapy if needed – or may have unmonitored, unsafe oxygen use, risking damaged eyesight. Pulse oximetry to check oxygen levels and other essential medical devices should not just be for the rich. Robust, wind up powered devices and universal probes could change this.

Advances in vaccines, drugs and diagnostics have revolutionised healthcare in the last few decades. Mhealth is bringing change at a rate we could not have imagined even a few years ago. Yet millions of mothers and babies continue to die needlessly, and many more have long term impairments. Each year 1.2 million babies die as intrapartum stillbirths, plus around 800,000 neonatal deaths happen from childbirth complications, closely linked to thousands of maternal deaths, or women who suffer an obstetric fistula. But our solution menu for childbirth complications has remained the same for centuries. Caesarean section was first done in ancient Roman times. Obstetric forceps were invented in the last 16th century by Dr. Chamberlen, the royal obstetrician. Vacuum extraction is modern -invented a mere 170 years ago. If health innovations were prioritised by the size of the problem, this challenge would be near the top of the global list.

During the Alma Ata primary care revolution of the 1970s and 80s, there was an emphasis on technology and on medicines. Essential drugs lists and generic drugs have enabled access to medicines, yet “appropriate technology” went out of fashion. The focus on higher coverage of “simple, low-tech interventions that work” should include investment in strategic research and development to more effectively and efficiently reach the poorest families.

A building in the hospital I was born in. Hospital maintenance workshop or medical equipment graveyard? A high proportion of medical equipment fails to save lives – too costly to get where it is needed, too complex to use, too dependent on electricity and disposable parts, too fragile or hard to clean. Appropriate technology is designed fit for purpose and fit to work in the context needed to save lives.

Appropriate technology is sometimes called “poor solutions for poor people” but the opposite is needed. Families and frontline healthworkers in the poorest settings have greater challenges. Truly appropriate devices must be more cleverly designed to be fit for purpose - robust, able to deal with heat, humidity, dust and unstable electricity, as argued by Dr. Francois Bonnici, from PET. We need smarter devices for the greatest challenges in global health and to function in the most challenging settings. And we need to get the message out so that the smartest minds are working on the right challenges.

Yet technology is not magic – a device cannot save lives without health workers to deliver it, which are also urgently needed. To accelerate innovation, we need a rational, data-based approach to prioritize which investments are likely to save more lives. MANDATE, an initiative from RTI International, has developed a model to help analyse the potential of various technologies to save maternal and neonatal lives and help prioritize the efforts and investments that will have larger impact for women and newborns.

The Grand Challenges for global health, launched in 2003 by the Bill & Melinda Gates Foundation, has sparked a new way of thinking and fosters scientific and technological innovation to solve key health problems in the developing world. Over 2000 applications have been received and awards have been made to more than 600 bold researchers from nearly 50 countries, totalling about half a billion US dollars. Many feature inter-disciplinary efforts, with work from leaders in fields such as chemistry, engineering, economics and business, bringing fresh ideas to global health approaches.

Grand Challenges meetings play a key role in the process of accelerating innovation and technology by linking discovery, development and delivery experts with industry, and stimulate thinking around reducing delays in commercialisation from an early stage in development. The last meeting, held in New Delhi, was the first to have a major focus on Family Health, showcasing ideas for contraception and for the care of mothers and newborns. However, advances are behind those for vaccines and diagnostics.

A new Grand Challenge, Saving Lives at Birth has begun to change this. Early 2011, the call was made for groundbreaking prevention and treatment approaches for pregnant women and newborns in rural, low-resource settings around the time of birth. Over 600 proposals poured in, and awards were granted to 19 seed grants and 3 transition grants– many from low income countries. Many could be game-changing, such as the development of a novel system for oxytocin to be inhaled from a simple, disposable device immediately after childbirth to prevent postpartum haemorrhage, the leading cause of maternal deaths, or a wind-up powered fetal heart rate monitor to help identify if a baby is not receiving enough oxygen and may die or suffer brain damage. Grand Challenges can catalyse such ideas and enable connections between experts in real world intervention delivery, trial design, regulation and advance market planning.

Preventing preterm birth is another new Grand Challenge that sets out to advance research on a key issue which is a knowledge gap across rich and poor countries around the world. Innovation in delivery of care and in devices is urgently needed to address the main cause of newborn death and save the lives of almost one million preterm babies who die each year, most of whom could be saved.

Today we launch a series of blogs on the Healthy Newborn Network about technological innovations for maternal and neonatal health – from Odon to wind-up powered devices, from MANDATE to mhealth, to the social and market disruptions needed.

Appropriate technologies in the hands of frontline health workers would bring major breakthroughs in our fight to save more lives. An Argentinian car mechanic and others have begun showing the way – who will be next?

Read the series: 

Adapted from a presentation at the Grand Challenges meeting in New Delhi meeting, Nov 5th 2011.

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