New butter/Nutributter® now being tested for pregnant moms

Maternova — Tue, 21 May 2013 17:26:39 +0000

By this point, you may be familiar with Plumpy'Nut®, the miraculous peanut paste in a foil pouch that is being used to treat children with severe acute malnutrition in communities around the world. To recap: the genius of this innovation is that children can be treated at home rather than as inpatients.

But what you may not know is that a variation of Plumpy'Nut®'s sister product, Nutributter® is being tested for improving the odds for pregnant women and their infants. Nutributter® is also a micronutrient-fortified semi-solid paste. It's also known as a lipid-based nutrient supplement (LNS). And the new formulation is called LNS P&L-- we can be sure that they'll come up with a catchier name when the studies are done. LNS P&L is being studied in government hospitals in Ghana (Atua and Akuse, and the St Martins de Porres Catholic Hospital at Agormanya (Manya Krobo District of Ghana), and the Somanya Polyclinic at Somanya (Yilo Krobo District of Ghana).

We found out about this trial from our friends at Edesia , the factory down the road which pumps out metric tons of Nutributter®, Plumpy'Nut® and Plumpy'Sup® every month.

Here is a snippet from the study design listed on clinicaltrials site:

> LNS-20gM) will, in addition to the multiple micronutrients provided in the MMN, supply
> energy (118 kcal/d), fat (11 g/d), protein (2.6 g/d), the essential fatty acids linoleic acid
> (=1.29 g/d) >and a-linolenic acid (0.29 to >0.6 g/d), as well as calcium, phosphorus,
> potassium and >magnesium.

The study will assess key metrics in the mothers (BMI, anemia, breast milk composition and interestingly, depressive symptoms). In addition, children will be studied until 18 months of age for their physical growth, motor skills, neurobehavioral skills and development, anemia and more.

Here's a question: What happens if at birth all of the health metrics of mother and infant are dramatically improved? Will the project report interim results? Will the world know? We aim to bring you updates as soon as they are available.

Checking in on... the State of the World's Mothers Report

Maternova — Wed, 15 May 2013 13:11:56 +0000

The first day of life is also the most risky, both for the infant--and often for the mother. This year's report on the State of the World's Mothers came out last week. The focus of this report is on the first day of life. Save the Children, authors of the report, developed the first-ever "Birth Day Risk Index" to assess newborn odds of survival on that very first day that they are born.

What is really striking in this report and in this new index is the extreme vulnerability of newborns during their first month, first week and first day and hours of life. The report breaks it down in a stark series of statistics. 60% of newborns die in the first month of life. Of these, 2 million die during the first week of life. And of these, 1 million die in the first day of life.

What also stands out is how poorly the United States fares as compared to other industrialized nations. In fact it it is dead last amongst its peers. In fact the report finds that the U.S. has 50 percent more first day of life newborn deaths than all of the other industrialized nations combined.

Part of the reason that newborn deaths now stand out is because such great progress has been made in reducing child mortality.

So what is to be done? The number one recommendation, with which we concur wholeheartedly is "Address the underlying causes of newborn mortality, especially gender inequality." Educated, well-nourished girls with access to family planning can make choices which enable healthier families.

For the direct clinical interventions, the report stresses:

Antenatal steroid injections to prevent preterm labor

Chlorhexidine for umbilical cord care

resuscitation during the golden minute right after birth

injectable antibiotics for pneumonia

education about breastfeeding and warming the baby

These simple interventions prevent 3 out of 4 newborn deaths.

Miracle Cleanse for the Umbilical Cord: Chlorhexidine and Neonatal Navels

Lizi — Wed, 24 Apr 2013 21:48:33 +0000

The period between birth and the first week of life is one of the most treacherous for a newborn and its mother, and in low-resource settings the high risk of infection compounds the dangers to both. One of the more common threats to newborns, particularly in these settings, are umbilical infections, which render a newborn’s umbilical cord both a line to life and an anchor for deadly infection.

Recent studies in Nepal, Bangladesh, and Pakistan have unveiled a solution that is simple, inexpensive, and highly effective: applying chlorhexidine solution to newborn navels during the first week of life staves off umbilical infection. According to a study out of Johns Hopkins University, more than 40% of the 8.8 million children under 5 who die each year are neonates--and in resource-poor regions, more than half of them die of serious infections.

Infants’ risk of infection and death during the first weeks of life is reduced by 24% if chlorhexidine is used to clean the umbilical cord for 7 of the first 10 days after a child is born, the study reports. More importantly, this method is a “simple, safe, effective and inexpensive intervention,” as JHU’s Abdullah Baqui explains. What's more, “large-scale implementation of this intervention with universal coverage has the potential to avert an estimated half a million neonatal deaths a year.” Half a million!

Like all the best solutions, the chlorhexidine method requires minimal training, reports a USAID brief, and is adaptable enough to be delivered in settings of all kinds. The supply stream is straightforward and broad-reaching, as “chlorhexidine can be delivered to women through existing health services as well as through retail outlets and by community health workers.”

These findings began with Plan International’s efforts in Nepal in 2010. Plan Nepal partners with community-based organizations in regions throughout the nation with all manner of children’s health-related focuses, from improving newborn health to child protection and child-centered disaster risk management. Within the realm of neonatal health, its LIBON (Local Innovators for Better Outcomes for Neonates) program has made remarkable progress in the last year alone:

According to ts annual report, Plan Nepal trained 257 health workers, established 400 pregnant women groups, taught pre- and post-natal care to 6000 women, equipped and established 46 birthing centers, and performed antenatal checkups in health camps for 9000 women. The program involved teaching women how to monitor their own pregnancies, communicate concerns about behavioral change, recognize the seven signs of danger during a pregnancy and what to do when they arose. It also solidified the care network in place using the Local Health Governance Strengthening Programme to expand local civic, health care, and government involvement in improving maternal and children’s health.

The studies in Bangladesh and Pakistan followed the successful work begun in Nepal, and have resulted in joint efforts such as the Chlorhexidine Working Group, an “international collaboration of organizations committed to advancing the use of 7.1% chlorxhexidine digluconate for umbilical cord care through advocacy and technical assistance.” For you technophiles, there's more: just this March, contributing partners released a technical brief on the wide-ranging successes of this method.

This is the kind of solution we like in global health: uncomplicated, inexpensive, easy to deliver, simple to teach, and above all, highly effective. So please, send the word down the line: chlorhexidine cleanse on a newborn for the first week of life, especially in resource poor settings, has a dramatic effect on the likelihood that child will survive. After all, umbilical cords should be newborns’ lifelines, not anchors for life-threatening infections.

By: Lizi Jones

Maternova Joins the Fight for More Frontline Health Workers

AECote — Tue, 23 Apr 2013 16:33:04 +0000

Simply put, the world needs many more frontline health workers. If we’re looking for an approximate number it would be adding 350,000 to global health efforts through 2015. Seems like an attainable goal, right? Not so fast… the job description isn’t glamorous, low pay (if any pay at all), and nearly zero benefits. People are hardly clamoring to dive into a vocations with a notoriously high burnout rate.

Why is this so critical? In many countries there are less than one physician per 10,000 people. If you are lucky enough to be seen by the doctor, the wait time has to be life threatening in itself. It’s also safe to presume that even the best physicians get tired, and quality of care has to be impacted when there is absolutely no respite or help provided.

One group is looking to change the landscape for global public health forever. The Frontline Health Workers Coalition brings together nearly all the power players in NGO’s alongside fantastic corporate partners. This unified front is aiming to reinvent the frontline health worker role. By providing training, support, supplies, and in some cases compensation, the tide is beginning to turn.

Maternova has been accepted as a member in this prestigious and motivated group. True, we’re not a Pfizer, or CARE, but we’re a loud voice for championing the causes affecting women and children globally. Helping speed up the success of the Coalitions’ mission will be our focus and I’m sure we’ll keep you all in the loop as we set off among very good company for a game changing mission. Join us! Together we CAN change the world.

a.e.cote 4/2013

More on the improvised anti shock garment made of bicycle inner tubes

Maternova — Mon, 15 Apr 2013 18:39:06 +0000

A bicycle inner tube? Where were we on this? Well to continue the story, in 2009 Drs. Mark Hauswald, Nancy Kerr and colleagues published in the International Journal of Emergency Medicine. Their findings were on an improvised pneumatic anti-shock garment. At that stage, the device was three inner tubes, one around each leg and one around the pelvic area. The tubes were pumped up to 45 psi. They found that both the improvised (bike tire) device and the non-pneumatic anti shock garment decreased distal aortic blood flow but that the improvised device decreased it by a higher margin.

As you can see in the photo above, the team has progressed rapidly. Fast forward to today where the team has a Saving Lives at Birth grant securely under their 'belts' and is piloting the project in Nepal. The training and pilot took place over 8 months and the midwives who were trained all still have their devices at the ready in their villages. Hauswald notes that the Nepali midwives are well-trained and very, very opinionated. This will ultimately result in a long development process but a much better end product. At present it is sewn with a (kelly green) bedsheet and bicycle inner tubes that could be manufactured inexpensively almost anywhere.

Though training and use of the device is going well, Hauswald and team want to do a trial in a community hospital next. He points out that if this is seen as a 'smart, modern solution' useful in hospital settings, it will the be better accepted by midwives and nurses in non-facility settings and by higher level policymakers. He would also like to another trial in another setting and another culture.

In the course of our conversation, Dr. Hauswald also mentioned the use of a 'soccer' or football or a knee (yes, knee) to exert pressure and counter arterial bleeding. As he said, 'you need to do what the marines do in the field.'

We'll keep you posted on the next steps in this exciting development in the battle against maternal mortality.

Under Pressure: Count bicycle tire tubes among the new solutions to help mothers in low-resource settings

Maternova — Thu, 11 Apr 2013 16:03:30 +0000

We've been following the MOM-CAPP device with great interest. Since we are already fans of the non-pneumatic anti-shock garment, how could we not be intrigued by a potentially faster/better version, a pneumatic anti-shock device, that could be locally made?

So let's first cover the definitions-- pneumatic means that the clinician pumps up the device (in this case with a bike pump) while non-pneumatic means.. no pumping involved.. just pressure from the tightness of the velcro and the ball built into the NASG which presses against the abdomen.

It occurs to me here that if our ancestors had come up with a simple pressure device to stop postpartum hemorrhage around the time they came up with the wheel we would be in a lot better shape today as a society. In any case...

We had the pleasure of talking with Mark Hauswald, and ER doctor, who along with his wife, Nancy Kerr, an obstetrician, works in Nepal on the CAPP. The CAPP, a circumferential abdominal pelvic pressure device, wraps around a woman suffering from postpartum hemorrhage. Mark's team presented multiple results at the FIGO meeting in the fall.

The current prototype MOM-CAPP was made in Nepal out of sewn bedsheet cloth and a bike pump and bicycle tire tubes. 58 nurses and auxiliary midwives were trained in the device were part of the study. 25% of them ended up using the device in a clinical emergency because they needed them and they were available. To find out the results, stay tuned for our next blog on the subject.

But we leave you with a thought: leaders in the field say again and again, we know what to do, we just need to scale it up. Well that's true in some cases, but innovation always plays a role in making is smaller, faster and cheaper. We did not know, even three years ago that this MOM-CAPP idea would work.. and now it appears, we do.

One Word Describes Rape & Sexual Violence: Everywhere

AECote — Thu, 11 Apr 2013 15:24:44 +0000

Last night while I was dutifully scouring the web in search of the latest news relevant to our mission here at Maternova, I was taken aback by an article describing the recent suicide of a 17 year old girl in Halifax, Nova Scotia. Rehtaeh Parsons was only 15 when she was gang raped by four boys at a friend’s home. After the attack the boys thought it would be fun to send photos of the rape across the social media landscape. A full two years later, after being relentlessly harassed and bullied, she hung herself in her family home. The boys have yet to be brought to justice due to ‘insufficient evidence’. Are photos not recognized as evidence in any court? Can someone explain to us how this heinous crime has gone unpunished? A mother has lost her child in a way that makes any mother cringe and shudder. Where is the justice for our girls? It’s almost amusing that the G8 Countries just yesterday made a collective statement to end rape in areas of conflict. The United States and Canada are part of the forum now fraught with passion towards the plight of women? Something’s being championed for headline purposes only, since they clearly don’t practice what they preach.

Rehtaeh’s rape happened in Canada, but rape and sexual assault are all too common in our own country. It’s estimated roughly 90,000 rapes are reported in the U.S. annually. The key word in the previous sentence is 'reported'. We all know the incidents of sexual violence are actually much higher and much more insidious. We live in a "rape culture", don’t be fooled or lulled into a false sense of security. More outrageous is that only 25% of accused rapists are ever arrested, and only a fraction will ever be convicted. The victims, however, receive a life sentence of trying to overcome the memory of what happened and manage the undeserved emotional and psychological demolition of their own being.

Maternova focuses on maternal and newborn health. But our focus extends beyond medical innovations to being a champion for all women’s rights globally. While recent statistics place the United States in the shameful top ten for rape occurrence worldwide, the data is suspect. An example that springs to mind is the Muslim community. A woman who is raped must produce four men to provide ‘eye witness’ testimony and corroborate her story. If this fails to happen, or even if she has three witnesses, she may be stoned to death. Women are brutalized then brutally killed by their community over and over again, and it is time it is stopped. You can see the rankings here.

Join us and be a voice for change. Our persecution as a gender is worldwide. It exists here at home and reaches to the far corners of the Earth. Our rights are being eroded right out from under us, by special interest groups and our continued silence on the issues that affect women worldwide. It can happen here, and it does. Help be part of the solution.

a.e.cote 4/2013

DIY to Save Lives: Creating a Self-Sufficient Relief Network in Africa

Lizi — Fri, 05 Apr 2013 22:16:11 +0000

The Do it Yourself (DIY) movement can sometimes, just sometimes, seem like it exists for the sake of itself. You know, just to prove you can do-it-yourself (build a radio, build a canoe, make an electrical circuit). But Advance Aid defies that stereotype. And we think it is a fantastic solution.

“DIY” is music to crafters’ and global health workers’ ears alike. Here, a handful of clever innovators have developed a series of simple tools designed to improve humanitarian conditions around the globe, with minimal training and expense.

These clever devices created in the field, for the field, improve access to clean water, diagnostic technology, renewable energy, communications, and of course, health care. Among them is a DIY AID-supply project designed to make Africa self-sufficient in generating and distributing its own emergency relief supplies.

The fundamental problem of relief supplies in Africa is one of simple supply and demand: the demand for aid materials vastly outweighs the ability of communities and nations to keep up. Coupled with an inability of African manufacturers to keep pace with China’s factories, and across the continent, nations must rely almost exclusively on imports from overseas to deliver what relief they can.

Advance Aid is an organization devoted to bridging the gap between producers and dispensers of relief supplies. Its strategy is to pre-position emergency materials in locations throughout Africa in order to leave those regions better prepared in the event of disaster. Storing these goods ahead of time cuts down on the delays caused when time, energy, and resources must be expended on scrambling to react to an emergency--and in turn, reduces lives lost in time of crisis.

Emergency materials include anything from “blankets and mosquito nets to basic cooking equipment and hygiene kits,” reports the Guardian, all of which are sourced as locally as possible. The organization is committed as much to the business component as to the stockpiling of relief materials: Advance Aid’s work provides jobs and establishes valuable business networks across nations, explains founder David Dickie.

The program has been most successful thus far in Kenya. In 2011, Advance Aid’s work facilitated, for the first time, an entirely African-sourced aid operation--80% of which came from within Kenya itself--to an African emergency. The Guardian expands upon the benefits of this self-driven and self-contained relief operation: not only did the process save lives, but it also “put $1.5 billion into the Kenyan economy, and brought orders to 12 local manufacturers.”

Self-sufficiency is the key to effective global health innovation. Advance Aid has helped regions across Africa improve their own emergency response systems, effectively empowering and enabling nations to DIY saving lives. Crafty!

By: Lizi Jones

You Get What You Pay For... Or Do You?

AECote — Mon, 01 Apr 2013 19:04:41 +0000

Many of us here in America might read articles or blogs online discussing the horrific state of maternal health and antenatal care globally. Perhaps we do this because we believe that our advanced medical infrastructure and sophisticated networks of highly skilled experts are the result of our highly evolved healthcare system. If you say the level and quality of care is clearly superior, you would be 100% correct. If you then say that we get what we pay for, then you’d be 100% wrong. In the USA right now, 40% of births are funded by Medicaid. This isn’t your private insurance obtained through employment. This is government or state issued medical care for the indigent or medically needy. Our tax dollars are collectively financing nearly half the births in our own country. We were shocked too!

The southern communities of Burkina Faso close to Bongo in the Upper East Region are bustling with the pitter patter of little feet. The world has taken notice of this healthcare model and begun to follow in our western footsteps. Right now, pregnant women in Ghana are breaking down the doors at clinics and hospitals registering for free antenatal care. The benefits of doing everything possible to ensure a baby is born healthy, has long ranging benefits. Overall, it reduces the likelihood of continuous medical treatment for birth related complications significantly. Second, providing mom with proper screenings and education provides her with basic tools for caring for newborns. This seems like a win-win situation, doesn’t it? It would be, were it not for the fraud being perpetrated by some expectant mothers. Problems have already arisen with volume of patients, and inefficient record keeping. They are more like the United States every day.

We applaud this first effort in Ghana to help our mothers and newborns. There is no data yet indicating the program’s success available. But there will be other countries following in Ghana’s footsteps. We hope they tread carefully and wisely.

a.e.cote 4/2013

Every Woman Every Child Breathes Life into the Neonatal Resuscitation Effort

Lizi — Mon, 18 Mar 2013 22:09:20 +0000

Nearly one quarter of newborn deaths result from babies failing to draw their first breath after birth. Yet, researchers estimate that newborn resuscitation could save 30 percent of the 814,000 babies lost to this condition each year. The process requires equipment and training that many low-resource birthing settings lack, however, greatly limiting the number of babies around the world with access to this life-saving--or life-giving--practice.

Neonatal resuscitation has been labeled one of fifteen focal points by the UN Commission on Life-Saving Commodities (we’ve written about the work of the Commission before). Last spring, Every Woman Every Child released a case study on the plight of neonates requiring resuscitation, which enumerates in detail the barriers of the problems and some possible solutions (find the full report here).

The problem with babies failing to breathe at birth, as is so often the case with maternal and newborn ailments in low-resource settings, is not a question of technology but of access. It is difficult to convince some nations to prioritize newborn resuscitation equipment, making the complications that already exist in delivering the devices and training seem insurmountable. Nevertheless, key studies in India and Indonesia have made the point that training village health workers in community based resuscitation does reduce asphyxia. The barriers to access include: high manufacturing and shipping costs from the faraway continents where the devices are currently produced, a lack of regional distributors in the low-resource regions in which the products are required, maintaining high quality in the life-saving tools, and keeping up with the enormous demand for the devices.

The relatively sophisticated battery of resuscitation devices require specific manufacturing facilities, meaning the products are usually shipped internationally and rarely succeed in supplying beyond tertiary and district hospitals. This leaves lower-level hospitals and rural childbirth centers who need them most, without means of saving newborns who fail to breathe at birth. The standard of care is a self-inflating bag and mask device.

While some groups hold that the OPTIMAL equipment for neonatal resuscitation requires a (relatively) expensive kit and training--a neonatal bag-valve mask, suction devices, a resuscitation training mannequin, and tactile stimulation training--many midwives in the field stress that a large number of lives can be saved with a simple alternative. The nasal aspirator bulb (if you've had infants it's the balloon-like rubber ball with a snout) provides a simple and cheap way to suction mucous from a baby who is not breathing. Many midwives prefer the aspirator bulb to more sophisticated mucous traps and other devices.

Suction bulbs are cheaper and simpler than mucous traps and other devices. They require less training and are much more likely to make it to the edges of that network to assist newborns. Bulbs certainly have limits--they do not provide the positive pressure ventilation required to revive many neonates who fail to draw breath, for example. They do not take the place of the bag-and-mask. The nasal aspirator bulb also has the drawback of spreading infection if the inside of the bulb is not properly cleaned.

This does indeed bring up the thorny questions of OPTIMAL versus ADEQUATE? IDEAL versus PREFERRED by end users? What are your thoughts?

By: Lizi Jones