The Hospital for Sick Kids in Canada, in partnership with Aga Khan University, are using an effective human resource and a set of proven, simple interventions to save brains in Pakistan. The secret sauce? Equipping Lady Health Workers, a unique an powerful home visiting cadre in Pakistan, with a kit of newborn interventions.
The intervention takes place in Rahim Yar Khan district, 700 kilometers northeast of Karachi and will determine whether this set of innovations can reduce infant mortality in this region by 30-40 percent. The kit includes the Maternova mylar blanket, the ThermoSpot thermoindicator, a warming mattress, sunflower emollient and the very powerful but low cost chlorhexidine (for the umbilical stump).
We know from studies in South Asia that sunflower oil as an emollient can prevent infections that enter newborns through the skin. Studies have shown dramatic effects of chlorhexidine applied to the umbilical stump. We also know that infant hypothermia (being too cold) can affect the health and neurological development of a newborn. Maternova researched and source mylar hooded blankets for newborns and rebranded the ThermoSpot, a stick-on infant hypothermia indicator that lets non-literate, non-numerate mothers know when the baby is too cold. Special heating mattresses can then help the infant regain healthy core body temperature. Put these interventions all together and you have the newborn kit funded by Baby Hero.
The study will train almost 200 Lady Health Workers how to teach use of the kit to mothers in some 600 villages. Lady Health Workers will visit toward the end of pregnancy and then five times after the birth. In an area where about half of births occur at home, this level of social and medical support is critical to improving newborn outcomes. This study goes farther than newborn health to assess whether the effects of the interventions in the kit have longer term impact on kids. In an article reported in the Huffington Post, the principal investigator for the study, Dr. Shaun Morris, states that " the kit may also improve cognitive development in surviving children through reducing serious insults that occur at a particularly important time for the developing brain."
The study will test the theory that the newborn kit could have long-term implications for neurodevelopment by administering a special test when the infants in the study reach one year of age.
We look forward to the results of the study with great anticipation and to working with additional partners interest in the newborn kit or adaptations of it. Clinicians and policymakers should watch for these results as each of the interventions is inexpensive and simple to administer.
The BiliDx is a novel system for diagnosing jaundice. The device uniquely meets the Target Product Profile (TPP) developed as part of the NEST 360 initiative in that it allows blood-based testing at the bedside. This initiative is part of an emerging global consensus in the Every Newborn Action Plan that countries need functional WHO level-2 inpatient units to care for "small and sick newborns."
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.