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Dosificación de medicina antirretroviral a recién nacidos dentro del Programa de Prevención de Transmisión Materno Infantil de VIH de Fundación VIHDA y Hospital Maternidad Sotomayor
Luego de estudios y comparaciones con otros métodos de administración de medicinas realizadas por Fundación VIHDA de Ecuador y Duke University de EEUU desde 2012 a 2015, el Pratt Pouch se muestra como una opción de gran exactitud y de mayor facilidad a la hora de dispensar los antirretrovirales líquidos a los niños recién nacidos en las dosis correctas y con una óptima conservación del contenido.
La prevención de la transmisión materno infantil del VIH implica la detección temprana del virus en la mujer embarazada. La toma de medicación antirretroviral (ARV) durante la gestación por parte de la futura madre, la administración de ARV intravenoso durante el nacimiento, y la toma de medicación ARV líquido al niño recién nacido por vía oral, son procedimientos que se cumplen a fin de reducir a menos del 2% la transmisión materno infantil del virus del VIH.
En Ecuador la medicina ARV oral para recién nacidos llega en presentación de frascos de 240 ml. Por lo que de 1 frasco se puede administrar medicación a 2 niños aproximadamente. Esto implica una dosificación personalizada a cada niño, donde se considera también el peso del recién nacido. Anteriormente, al dosificar la medicina se la entregaba a las madres en recipientes individuales esterilizados con la cantidad...
How can severe malnutrition be determined locally?
Severe malnutrition can readily be determined without scales, with minimal training and with objective accuracy. The mid-upper arm circumference (MUAC) has been endorsed and recommended as a reliable screening tool for acute malnutrition. It is an easy and objective measurement that can be followed over time. An important update to this MUAC approach is a recent study that proves even minimally trained persons can use the inexpensive color coded bands to measure a small child or infant’s arm circumference.
This home-based approach allows much easier screening for severe malnutrition in areas with little access to trained medical personnel. Since the results have been determined to be reliable, MUAC can be used by a mother to monitor the nutritional progress of her child, thereby she can play an even greater and proactive role in the complete care of her child.
This band with graduation in millimeters has an easy to read color code: green, yellow and red indicating the risk/severity of indicate the nutritional status of a child or adult. The color coded bands can be used by a minimally trained person to measure the diameter of the upper arm of a 6 – 60 month old. Severe acute malnutrition (SAM) is indicated by a red reading.
This study, published in the Archives of Public Health, demonstrated that there is no difference between measuring the dominant vs. non-dominant arm as was previous...
Pratt Pouches have been in the development for over three years. This foilized pouch is a medical device designed to improve the delivery of antiretroviral therapy to newborns.
Who developed these pouches?
Robert Malkin and the engineers at the Developing World Healthcare Technology Laboratory at Duke University’s Pratt School of Engineering saw a need and sought to find a medically effective, simple and cost effective solution to an ongoing dilemma in the fight against HIV. Ironically, the class originally set out to look at failure (why ARV dosing devices were failing) and they ended up creating a solution
What so difficult in giving ART to newborns?
It is well known that giving newborns antiretrovirals in the first 24 to 72 hours drastically decreases the transmission of HIV from the mother to baby but the means to do so in areas most in need is prohibitive on two fronts. In areas most in need, more than half of the mothers deliver at home with little access to a clinic or community health workers. The only way to ensure that the baby gets these lifesaving drugs is to give them to the mother to store before delivery (sometimes months before delivery) with easy to follow instructions and adequate shelf-life. Other delivery methods, including a pre-measured syringe in a sealed foil pack, have been tried in the past with unsatisfactory results.
Laboratory testing of the Pratt Pouch’s design and stability of medication
Introducing an exciting innovation in the effort to reduce HIV transmission to newborns
The drugs aren’t new, but this new delivery system provides an innovative solution to on-going obstacles AND is amazingly simple. The Pratt Pouch is a small package resembling the ketchup that comes with your takeout, but the Pratt Pouch is filled with a precise dose of antiretroviral drugs. Studies have shown that immediate treatment of newborns with antiretrovirals significantly reduces HIV transmission from mother to baby. These drugs have been readily administered in the clinic setting but the challenge continues to be in areas where women deliver at home. The drugs, in a single dose Pratt Pouch, have a remarkable shelf life of 12 months.
How is it distributed and administered?
A local pharmacist prepares individual doses in a sanitary setting, sealing each packet with a heat sealer and gathering them to be distributed later. These user-friendly packages are simply torn open and the suspension gel dripped into the newborn’s mouth.
In areas with prenatal care, an expectant mother who is HIV positive receives the required dose(s) well in advance of delivery to be administered in privacy of her own home. The Pratt Pouch can be made available at regional clinics or distributed as part of outreach trips by community health workers. The small size and home use make the Pratt Pouch discreet thereby helping address the on-going stigma associated with...
It always inspires us to talk with people like Dr. Lowell Schnipper, an oncologist who is running a cervical cancer detection initiative out of St. Albert's Mission Hospital in Zimbabwe. The work of this team emphasizes prevention, ultra low-cost methods and an emphasis on building local capacity. Cervical cancer hits women of childbearing age and puts families at risk of losing their mothers. We interview Dr. Schnipper here:
Can you set the stage for us? What was the standard of care for cervical cancer treatment and detection?
Until recently there has been very little cervical cancer screening in Zimbabwe. Fewer than 10% of women have have been in a regular program of cancer screening, and my guess is that most of these are in the private sector. Several years ago the Ministry of Health developed an ambitious plans for screening for cervical cancer throughout the country employing a technique called Visual Inspection with Acetic Acid and Cinematography (VIAC). There have been trainings for medical staff (physicians and nurses) across the country; to my knowledge the program has not been widely disseminated for reasons of lack of funding for appropriate personnel. Thus, one would say that the idealized standard of care in the country is to screen women between the ages of 21-65, but to my knowledge this has not happened except at the largest hospitals.
How many women do you see in the catchment area? What is the incidence and prevalence of...
Providing high quality antenatal care for expectant mothers is a fundamental part of ensuring a safe delivery, and a healthy mom postpartum. In order to do that, some innovative products have been introduced for low resource settings. There’s no denying the importance of ultrasound technology during pregnancy. However, until fairly recently, it has been out of reach for many caregivers due to high cost, or complex application. We’re very pleased to announce: that has all changed.
Who’d have guessed that the invaluable insight provided by ultrasonic technology would be able to fit in the palm of your hand! ?The Signos-RT, a wildly effective handheld unit has both FDA approval and CE marking making it ideal for global adoption. We recently checked in with one of our most ambitious and remarkable friends, Jill Gerber, Nurse Practitioner, as she traveled into Haiti armed with the Signos-RT and asked her what she really thinks about this addition to the Maternova product portfolio.
Jill traveled to the Clinic of Mizak, located in Mizak, Haiti with the group HAPI (Haitian Artisans for Peace). This is what she had to say about the ease of use, and overall benefit of having access to such a miraculous device:
“We spent an afternoon training on the device, mainly focusing on the nurse midwife that would be utilizing it for her patients. The first time we used it on a patient was exciting for everyone in the room! I began demonstrating and then turned it over...
We are happy to announce a new partnership with a creative U.S. based team-- the folks at Mommy Measure. Mommy Measure uses the concept of fundal height as a way to empower pregnant women in the U.S. to track one of the parameters of pregnancy-- the growing belly!
Maternova has been working with Mommy Measure to translate this device into a variation useful for antenatal care settings in lower resource settings. The obstetric measuring tape can be used by midwives to identify pregnancies that may be at higher risk.
Though not a perfect measure, the symphysis-fundal height can be used to complement other methods of tracking pregnancies. Particularly useful in the second half of pregnancy, the fundal height measures, in centimeters, the length/height from the top of the woman's public bone to the top of the uterus. This measurement actually correlates with the weeks of gestation. Thus a measurement of 22 cm is approximately indicative of a normal pregnancy at 22 weeks (plus or minus).
The fundal height measurement, according to the literature, is most useful in terms of tracking a pregnancy over time-- does the height continue to increase every two weeks and correlate with the gestational age? If dramatically off, it MAY signify a problem that needs further exploration. For example, if the fundal height were dramatically lower than expected, it might signify intrauterine growth retardation (IUGR) and a risk of a low birth weight baby, for which...