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Archives for Global Health

Saving & Empowering Lives through Clean Cooking Innovation

During the month of May, IMPACT will be highlighting USAID’s work in Global Health.

A major study published in December cited high blood pressure, alcohol, and tobacco as the top three health risks in the world. Could you guess the fourth? You probably did it last night.

The seemingly simple act of cooking a meal is responsible for 4 million deaths each year.

That’s because nearly 3 billion people burn solid fuels such as wood, charcoal, coal, and other fuels to cook every day. When burned in open fires and basic stoves, solid fuels emit a harmful smoke that causes a range of cancers, heart and lung diseases, developmental and neurological impacts, cataracts, and more.

Example of a pine needle powered cook stove. Photo credit: USAID

Inefficient and dangerous cooking practices are also a major cause of burns, and the acts of collecting and burning fuelwood lead to deforestation and the release of climate-changing gases, respectively.

Women and children have the primary responsibility for cooking and fuel collection in developing countries, and are therefore most at risk from the side effects: smoke inhalation, crippling burns, time lost for schooling or work, human or animal attacks during fuel collection, and myriad others.

But, you’re probably asking, how can technological innovation change such a seemingly intractable and global challenge? Enter the Global Alliance for Clean Cookstoves.

Launched by then-Secretary of State Hillary Rodham Clinton in 2010 with 19 founding partners under the leadership of the UN Foundation, today, the Alliance is comprised of more than 650 partners across 6 continents. They’ve joined the Alliance to save lives, improve livelihoods, empower women, and protect the environment by creating a market for clean, safe, efficient, and affordable cooking solutions. Our goal is for 100 million households to adopt clean cookstoves and fuels by the year 2020.

With our partners, including founding partner USAID, we are taking an all-of-the-above approach to ensure that as hundreds of millions of people enter the global middle class, they no longer cook as their ancestors have done since the beginning of human history:

  • Research: We are commissioning research with cookstove and fuel interventions that will help us better understand how to achieve the cleanliness and efficiency markers essential to save and improve lives and the environment, and to underscore once and for all that this is a major global development challenge that deserves awareness and funding on par with similar crises.
  • Standards: International standards to define cookstove cleanliness, safety, and efficiency had never existed until the Alliance and the Partnership for Clean Indoor Air began working with the International Organization for Standardization (ISO). The interim system that has been adopted is now in the process of being translated into permanent standards. A tiered system through the ISO will create global norms and strengthen a market for clean cooking solutions.
  • Testing centers: To carry out those standards and further propel local manufacturing and testing, the Alliance is supporting the enhancement or creation of testing centers in 12 countries worldwide. Previously, most stoves had to be sent to North America or Europe to be tested, proving very costly for manufacturers and impeding local growth of markets.
  • SPARK and Pilot Innovation Funds: The SPARK and the Pilot Innovation Funds are part of our plan to increase the level of resources, grants, and investment in the clean cooking sector. Each year, we will support entrepreneurs and innovation through at least $2.25 million. This year’s Pilot awardees were recently announced, and we look forward to announcing the SPARK recipients later this month.
  • Input from consumers: Each of the above steps will be fruitless if we aren’t engaged in dialogue with consumers at each step along the value chain: food taste; cooking style; stove design, weight and color; manufacturing; distribution; purchasing; and adoption. The Alliance and its partners have strong relationships with community associations, women’s groups, and others to ensure we hear directly from consumers about their economic, health, and standard of living aspirations, and then translate that information into action.

The Alliance and its partners strongly believe that cooking shouldn’t kill, and because you are reading this blog during USAID’s Global Health Month+ series, I suspect that you do, too. Find out about all of our market-enabling activities and join us at www.cleancookstoves.org.

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The Power of Mobile Technology to Save Lives

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

The development field has been exploring for years ways to harness the power of technology to benefit those in need, especially mobile technology, which can reach people in remote areas who need food, health, education, and other assistance quickly and well.

A health worker refers to her mobile phone for information while making a house visit. Photo credit: World Vision

Health is an area in which the benefits of mobile technology are obvious. One initiative World Vision is especially proud of is our mobile health (mHealth) projects  in 13 countries. Our mHealth projects leverage the ubiquity of mobile phones to deliver information to, and receive information from, patients and caregivers and can address a broad range of scenarios, including announcements, targeted messages, appointment reminders, medical records for patients, treatment reminders, training and tools for front line health workers and volunteers. Key mHealth principles that have been integrated into current and planned projects include: 1. Align closely with Ministries of Health and their partners; 2. Work in partnership with other funders, developers, and implementers to build on and add to global learning; 3. Design to meet the needs of local users but also provide the basis for maturing the evidence base; 4. Be initially affordable yet based on sustainable costing models and scalable technology; 5. Be respectful of data governance issues; 6. Utilize and strengthen government and partner information systems; 7. Emphasize coherence and quality of approach and program/project management; and 8. Favor open source solutions and emerging global standards.

To support mHealth, World Vision has strategically partnered with the Bill & Melinda Gates Foundation, Grameen Foundation, and Dimagi to create and deploy a World Vision version of the Gates-funded MOTECH Suite (MTS), a sustainable, scalable, open source mobile solution. MTS provides a set of capabilities encompassing five key functional mHealth areas: Behavior Change & Demand Generation, Managing Patient Data, Improving Worker Performance, Last-Mile Supply Chain, and Patient Adherence. This partnership allows World Vision’s funded mHealth projects to utilize a common, yet customizable, field-tested mHealth tool.

MTS was piloted in World Vision’s Afghanistan mHealth project (USAID-funded Child Survival Health program 2008-2013), and the evaluation results are encouraging:

  • significant improvement between intervention and control groups in any antenatal attendance (20 percent),
  • skilled delivery at a health facility (22.3 percent),
  • having a birth plan that included improved coordination with the health facility (12.6 percent),
  • saved money and arranged transport (12.9 percent)
  • knowledge of two or more pregnancy danger signs (12.9 percent).

A volunteer health worker refers to her mobile phone for information while making a house visit. Photo credit: World Vision

In World Vision’s Mozambique mHealth project (Gates-funded Grand Challenges 2010-2012), MTS research results indicated that pregnant women in the project’s intervention area had a higher likelihood of accessing antenatal care, prepare better for birth, and have their births assisted by a skilled provider. They were also more likely than those in the control group to know about signs of pregnancy complications and to seek care at a facility for that complication.

The advantages of the shared framework of MTS are numerous, from minimizing software development, operations, and support costs, to making available the source code, best practices, learning, and other assets to the global community to avoid duplication, and ultimately, save more lives. As World Vision rolls out MTS in additional countries and regions, we’ll analyze the complexity and economics of this versus other models, the interface with national Ministries of Health systems, impact, and sustainability.

Deployments of WV’s global version of MTS have begun in Sierra Leone, Uganda, and Zambia, with others to follow in Tanzania, Sri Lanka and India by this August. World Vision aims to increase geographical mHealth reach within these countries while enhancing MTS functionality at the community level. The focus is on creation of a solution that is globally deployable, meeting at least 80 percent of functionality needs for each project, and further customizable for each context. A key characteristic of this effort is collaboration with Ministries of Health and intentional efforts to forge public-private partnership agreements with mobile network operators and other potential private sector partners. This model has already effected notable reductions in duplication of effort and overall costs at the global level, as well as for each project.

Initiatives like MTS are the way forward for NGOs to impact the global health field, including reducing incidence of malaria, improving maternal and child health, and improving child nutrition. Read more about World Vision’s mHealth projects.

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Using Technology For STH Control

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

This originally appeared on the InterAction Blog.

I consider myself extremely fortunate and even spoiled in this 21st century with smart phones and so much mobile technology available. If I ever feel there is a need to make my life more convenient with technology, chances are I can go to the app store to download some utility that will help. And, even if it’s not 100% satisfactory, by virtue of having asked the question or conducted the search for this app, some techie out there is likely monitoring the query and I can probably be assured that in weeks, if not days, something better will be created.

So as I wrangle with the question of how the Neglected Tropical Disease (NTD) community can more effectively and efficiently manage our disease control and elimination programs around the world, I hark back to how we can leverage the fact that almost 75% of the world have access to cell phones. The NTD sector should be paying close attention to the opportunities presented by the proliferation of mobile technology.

There has been interesting progress in the use of mobile technology, like this smart phone, in the fight against NTDs. Photo credit: InterAction

In April 2012, attendees of the Ninth Global Health and Innovation Conference overwhelmingly agreed that a key to transforming global health is to push the development of social enterprises toward mobile technology. The reach of mobile phones into even the poorest and most remote parts of the world has shown these devices to be the tool of choice for civil and social transformation.

Those working in the HIV sector were some of the first to leverage the utility of mobile phones to check on people living with HIV. As a substitute for home visits, which are expensive, time-intensive, and far from discreet, mobile technology became a key factor in dealing with the stigma of HIV. Mobile phones have also been used to send reminders to patients and caretakers to improve adherence to antiretroviral treatment regimens. Another Johnson & Johnson supported mHealth program, MAMA, is bringing health information to pregnant women in more than 40 countries.

Considering that more than two billion people worldwide are affected by NTDs, the development and use of mobile technology for preventing and controlling NTDs has lagged. However, one bright spot for the NTD sector is the development of mobile technology tools to report on the global prevalence of trachoma. Using data collected through surveys leveraging smart phones and SMS, comprehensive prevalence maps of the disease have been developed, which will greatly improve the tracking and treatment of individuals infected with NTDs. As noted by Dr. Simon Brooker of the London Center for Neglected Tropical Disease Research in The Guardian earlier in the year, “maps are important to the control and elimination of NTDs … [and] only now are we starting to develop this blueprint.”

Mobile technology can be used in many other facets of the control and elimination of NTDs, for example, informing communities when and where treatments will be distributed, sharing messages about the causes of infection and how to prevent them, and collecting and reporting treatment data to health centers.

Recently, there has been even more interesting progress in the use of mobile technology in the fight against NTDs. Isaac Bogoch and other researchers innovated a way to turn the lens of an iPhone camera into a field microscope to detect intestinal worms in childrens’ stool samples. This is particularly timely because the global health community is ramping up the administration of medicines donated to treat infection with intestinal worms, also known as soil-transmitted helminthes (STH).

The increase of treatments globally will mean a greater need for diagnostic testing to monitor the impact and effectiveness of the programs. This concept of converting a phone to a field microscope would reduce the cost of the testing by eliminating the need for desk top light microscopes. It will also allow for images to be saved for enhanced analysis later or sent to a central repository for batch analysis almost instantaneously. In addition, as the increased use of anti-parasitic medicines will result in an overall decrease in the number of STH in the infected populations, a more sensitive and robust diagnostic tool is needed. The authors noted that this is, indeed, the first generation of the mobile phone microscope for resource constrained settings, but that newer technologies are certain to come along to improve its sensitivity and specificity.

These recent developments in mapping and diagnostics reassure us that mobile technology for control of NTDs is gaining traction. With two billion people on our planet at risk of NTDs, there is a market for mobile technology to eliminate or control the NTDs. There is clearly still much to be done. The NTD community must encourage and leverage this potential to maximize the health and development gains that can be made using this technology in all aspects of our work. The possibilities are limited only by our imaginations.

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Adding Vaccines to Intensify the Assault on Malaria

David Kaslow, MD, serves as Director of the PATH Malaria Vaccine Initiative. Photo credit: David Kaslow

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

At the turn of the last century, the call to action to bring to bear tools such as insecticide-treated bed nets, malaria rapid diagnostic tests and artemisinin-based combination therapies, was heard. Governments, foundations, non-profit groups, and the commercial sector mobilized to stem the tide against an ancient scourge—the result has been an estimated 274 million malaria cases and 1.1 million deaths averted between 2001 and 2010.

And yet, the fight against malaria is far from over and new tools will be needed to continue to build on these initial impressive gains.

Given these gains the World Health Organization (WHO) has undertaken an update of the 2006 Malaria Vaccine Technology Roadmap—a document developed through a consultative process to align the malaria vaccine development community toward common goals. In 2006, the Roadmap set a shorter-term goal—by 2015, develop and license a first-generation malaria vaccine that has a protective efficacy of more than 50% against severe disease and death and lasts longer than one year—which is expected not to change. However, the long-term goal will be updated to better reflect the global health community’s desire to eradicate malaria altogether and targets vaccines that interrupt malaria transmission (VIMTs) and that support the elimination/eradication agenda, including transmission-blocking vaccines (TBV). TBVs are designed to break the cycle of transmission, preventing the malaria parasite from passing from humans to mosquitoes. When used in conjunction with other technologies, a transmission-blocking vaccine could help a country push across the threshold from control to elimination and ultimately help achieve global eradication.

Although there is not an approved malaria vaccine today, several lines of evidence indicate that it is biologically feasible to develop one. A recent update by the WHO of the global malaria vaccine pipeline identified more than two dozen active vaccine candidates in clinical development. This list includes the most clinically advanced candidate, GlaxoSmithKline’s RTS,S, which is in the midst of late-stage Phase 3 trials in Africa. Results to date show that RTS,S cuts cases of malaria in half in toddlers and by one-third in infants, on top of the protection provided by bed nets.

The final set of data from the Phase 3 efficacy trial is expected in 2014, and will provide decision-makers with important information about RTS,S, including vaccine effect in different malaria endemic settings and the impact of a booster dose. And anticipated modeling outputs will illustrate how the vaccine candidate’s efficacy may translate into public health impact—another important input for decisions about the possible role of RTS,S in the future. Experience from vaccines to combat other diseases, such as rotavirus, has shown that the relationship between vaccine efficacy and public health impact is not always straight forward. Rotavirus vaccine efficacy is higher in South Africa than in Malawi (77 percent versus 49 percent – 60 percent greater in South Africa), but the vaccine’s impact in terms of cases averted is actually 60 percent greater in Malawi.

Building on the key learnings from RTS,S, and using unique tools, such as the malaria “human challenge model”, revolutionary new ways to accelerate vaccine development are being used to hunt for additional vaccine targets. The US Government, through multiple cross-sector collaborations, is at the center of much of this research. Initial breakthroughs in malaria vaccine science came from the Department of Defense and the National Institutes of Health—often with the support of USAID. And key elements of the global malaria vaccine pipeline are supported by USAID’s Malaria Vaccine Development Program, which, along with the President’s Malaria Initiative, has been integral to the successes made to date in the fight against malaria. Indeed, it is only through strong partnerships that the overall battle against this disease will be won.

The international community has made phenomenal progress against malaria, but the gains are fragile. More than 650,000 people still die from malaria each year, almost all of them young African children, and history tells us that when support for control programs wanes, the parasite resurges with a vengeance. Over the years, malaria vaccine development has progressed from a pipe dream to a pipeline, and adding a vaccine to the arsenal is more important than ever to vanquish this parasite. At the turn of the next century, malaria should exist only in the annals of eradicated infectious diseases.

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The Power of Mobile to Improve Women’s Health

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

Last month, I had the chance to visit a clinic in Nigeria just outside of the Federal Capital Territory where approximately 70 pregnant women were waiting to receive prenatal care. Being a big fan of impromptu focus groups, I asked the women to raise their hands if they had a cell phone. Hands shot up around the outdoor meeting space, many of them proudly clutching mobiles phones of all shapes, sizes and varieties. This was an exciting moment for me, a clear representation of just how ubiquitous mobile technology has become in low-income countries. The GSM Association estimates that the mobile penetration rate in developing countries is now 89%.

There is no doubt that the pervasiveness of mobile technology has made possible innovative new ways to deliver health information and services. mHealth projects throughout  the world are harnessing the power of mobile to do everything from registering births to supporting health workers to raising awareness about disease prevention (and a great deal in between!). Mobile phones have also become valuable tools for empowering women: more than 1 billion women have access to a mobile phone in developing countries, and 9 out of 10 women who use mobile phones say they feel safer and more connected with friends and family.

With a mobile phone, this mother has access to health information and services. Photo credit: VillageReach

Women, as mothers and health workers, are commonly the beneficiaries of mHealth projects. But even as we acknowledge the potential power of mobile phones to improve their health and wellbeing, it’s important to recognize that they are rarely equal participants in the development of these interventions or the policies that govern access and use.

I believe firmly that mHealth projects, especially those related to reproductive, maternal, newborn and child health, must take into account social, cultural and gender norms in order to produce improved health outcomes. This belief led me to work with my colleague, Madhu Deshmukh, who is seconded to the mHealth Alliance from CARE – a leader in the movement to promote the empowerment of women and girls – to develop a Gender Analytical Framework (PDF). Through this framework, mHealth implementers can better understand the nuances and implications of gender issues, and then design or modify their projects accordingly.

When developing the framework, we interviewed a number of organizations working on mHealth projects, including VillageReach, one of our grantees bringing a toll-free maternal health hotline to scale in Malawi. What VillageReach told us is that they have experienced first-hand the challenges of taking gender into account when designing mHealth programs, for instance when they realized men were calling into the service on behalf of their families. By creating this framework, the mHealth Alliance is providing mHealth implementers like VillageReach with a powerful tool that will help ensure women and men not only have access to mobile technology but that it is being harnessed in a way that truly benefits the health of pregnant women and their families, as well as the male and female health workers that serve them.

Returning to my unofficial Nigerian focus group, my second question to the women was how many had used their phone to obtain some sort of health information. Remarkably about half of the hands went up. When I probed, many shared that they used their phones to either call a family member or a health worker to seek advice about their pregnancy, though it wasn’t necessarily through a formal service.

In Nigeria, the government has recognized this power of mobile phones to empower citizens, health workers, and the health system through the Saving One Million Lives initiative.  They have also highlighted equity and gender, specifically, as key to ensuring that the full potential of mobile is realized to reach targets for significant reductions in maternal and child deaths and improvement in health and wellbeing.

As more services to provide access to health information are implemented by programs such as VillageReach and the Mobile Alliance for Maternal Action (MAMA), I fully anticipate that more women will be empowered to better care for themselves and their children. On my next visit to Nigeria, I hope to see the number of raised hands rise dramatically, due in no small part to mHealth implementers and designers applying a gender lens to their work.

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Netbooks Empower Community Health Workers to Improve Health in Bangladesh’s Poorest Communities

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

With a population of 150 million, Bangladesh is a bustling country filled with vibrant people. On a recent trip to Dhaka and Chittagong we experienced first-hand the kindness and welcoming spirit of the country. The goal of our trip was to meet with various USAID implementing partners, and several units within the Ministry of Family Health and Welfareto find out more about their behavior change communication work. Developing high quality, evidence-based communication campaigns that promote healthy behaviors is quite a challenge for Bangladesh with their large population, numerous rural communities, and with so many health issues that need to be addressed. These health areas range from improved antenatal and postnatal care, family planning, nutrition, and child health. USAID implementing partners and the Ministry of Family Health and Welfare are now streamlining their health communications work, making sure their messages are in agreement, effective, and accessible to a range of people of all ages and educational backgrounds.

Community health workers receive training on the new netbooks. Photo credit: Bangladesh Knowledge Management Initiative

A key part in this new effort was the launch of a three-month eHealth pilot program, developed by Johns Hopkins University – Center for Communication Programs in partner with Eminence, the Bangladesh Center for Communication Programs, and the Ministry of Health and Family Welfare, with funding from USAID. The pilot will take place in Sylhet and Chittagong where 300 community health workers have received a netbook computer loaded with several eToolkits that contain a digital library of communication materials in maternal and child health, family planning and nutrition, and eight eLearning courses. The eToolkit includes 116 materials and tools which were selected by a team after a detailed assessment and review. The eToolkit will improve the quality and effectiveness of counseling visits that the community health workers have with their clients, while replacing the heavy materials they previously carried from house to house. The eight eLearning courses on the netbooks are meant to supplement the training that community health workers currently receive. Each course also includes an assessment designed to measure changes in the knowledge and skills of community health workers.

Puspa Rani Paramdar, a community health worker, said she felt empowered with information and knowledge after she received the netbook. Photo credit: Bangladesh Knowledge Management Initiative

The eHealth pilot is one of the first large steps towards achieving a Digital Bangladesh by 2021. The use of digital resources will help extend the reach of key messages for health, population, and nutrition. In early April, colorful balloons and banners welcomed guests to the launch event for the pilot program in Chittagong. Here we witnessed the ceremonially hand-off of ten netbooks to community health workers before an audience of more than100 guests who were excited and engaged, asking interesting technical questions and offering suggestions for future iterations of the project.

On April 20-21, the first 30 community health workers attended an orientation, learned to use the netbook, and navigate the eToolkit and eLearning courses. Facilitators led an interactive orientation to ensure the community health workers felt comfortable operating the netbooks. There was much enthusiasm for the eHealth pilot program from the field workers during the orientation, who shared they felt empowered, informed, and energized to continue their important work.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Technologies to Keep Mothers Safe

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

This Sunday—Mother’s Day in the United States—will be a day of light hearts and laughter for many. At PATH, we’re dedicated to developing simple, affordable technology to make sure becoming a mother is a time of joy the world over.

Elizabeth Abu-Haydar, right, with a mother in a prenatal clinic in Rajasthan, India. Photo Credit: PATH/Noah Perin

In some parts of the world—notably sub-Saharan Africa—childbirth remains an extremely dangerous time in a woman’s life. Some 300,000 women worldwide die each year just before or after delivery. Excessive obstetric bleeding— postpartum hemorrhage—causes 1 in 4 of these deaths. And mothers who survive aren’t out of danger. Those who live through severe postpartum hemorrhage are significantly more likely than other mothers to die within a year’s time, leaving their babies and families alone.

Elizabeth Abu-Haydar, public health specialist with our Technology Solutions program, looks for ways technology can make childbirth safer. On May 28, she’ll be presenting her work at Women Deliver, an international conference focused on improving the health and well-being of girls and women. To celebrate Mother’s Day, we asked Elizabeth about some of the technologies that hold promise for making childbirth safer.

What will you talk about at Women Deliver?

I’m going to highlight some of the technologies we’re working on to fill a gap that occurs when women experience severe postpartum hemorrhage. There’s a clear protocol that’s followed when a woman starts bleeding after delivery: She’s given medication and her abdomen is massaged, and in 62 percent of the cases, that works to stop the bleeding. But in those other roughly 40 percent of cases, the woman could potentially continue bleeding, and if she’s bleeding severely, even a healthy woman can die within two hours. Most of these women are not as healthy as they could be, and the biggest problem is that many of them are anemic.

Why does anemia make the problem worse?

These women have low iron stores, and the body during pregnancy requires more iron. If a woman starts bleeding and she doesn’t have iron stores, she’s likely to go into heart failure and shock much more rapidly than a woman who is healthy. In sub-Saharan Africa, where 40 to 50 percent of the women are anemic, that’s a huge problem.

What can we do about it?

We’ve been testing a device that makes it very easy to assess whether a woman is iron deficient or not. We call it a noninvasive anemia screening device. The device measures iron levels using a clip that attaches to the woman’s finger. Ideally, you would use it every time she comes in for her prenatal visit. If there’s a problem, you can start treatment and monitoring. The screening doesn’t require blood, it gives a reading in less than a minute, it doesn’t hurt, and it’s visual, so that it becomes a way to talk about iron with the woman. Plus, there are no sharps and no waste and no resupply issues either, which is a big, big deal.

What do you do to stop the bleeding once it starts?

One option is the balloon tamponade. It’s basically tubing attached to a vessel, such as a condom, that is inflated by pumping water into it. It’s inserted into the uterus and filled until it stops the bleeding. It is very effective and it’s very affordable.

Another option is the antishock garment, which looks a bit like a tight wetsuit. Its main purpose is to reverse shock. If a woman has bled profusely and her organs are shutting down, she starts going into shock. That’s when the antishock garment gets wrapped around her in a sequential manner starting from her legs up so that the blood is pushed to her vital organs. You can combine the antishock garment with the balloon tamponade. It’s a beautiful combination!

You sound very motivated—even though developing technologies is a long haul. What keeps you going?

You know, I was in Kenya in August, visiting 13 clinics that were run by midwives—not fancy, these were serving the slums of Nairobi. We talked about the balloon tamponade, and a couple of midwives had used it. They talk about the woman who came in to give birth, and they really thought she was going to die, and there was no way she was going to make it to the hospital, and somebody said, “Why don’t we use this balloon thing they were telling us about?” And they try it. And the woman survives. And she comes back a week later with her baby. That inspires me. That’s very exciting, I think.

Additional Resources

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Improved TB Diagnosis & Treatment: Research and Innovation Urgently Needed to Address Global Epidemic

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

In 1882, Dr. Robert Koch discovered Mycobacterium tuberculosis, the bacteria that causes TB. In 1952, the first combination of antibiotics was used to treat. Today, thoughout the world, most people with TB are diagnosed with the same simple microscopy method that Koch used to identify the bacteria. Additionally, almost all are treated with the same basic antibiotics that have been used since mid-20th century. During the same time period, the HIV epidemic and spread of drug resistant TB have complicated diagnosis of TB. People with HIV who become sick with TB are less likely to be diagnosed correctly using simple microscopy, and this technique does not tell us whether or not the bacteria is resistant to anti-TB drugs. Moreover, with the alarming increase in drug resistant cases in recent years, we see the limits of available treatment. The drugs used to treat multi-drug resistant TB are not very effective and extremely toxic, and patients must take them for up to two years to achieve cure.

But the past decade has brought significant new tools to the fight against TB, including the Xpert MTB/RIF® diagnostic platform and potential new regimens to shorten the length of treatment. The Xpert test for TB diagnosis can tell us whether or not a person has TB AND whether or not the bacteria is resistant to Rifampicin, one of the most powerful anti-TB drugs, in less than two hours. Without Xpert, it can take up to two months to confirm drug resistance, which results in a long delay in starting appropriate treatment. Xpert is a relatively simple test that can be implemented with minimal training and infection control requirements, and recent negotiations with the manufacturer have resulted in a significant decrease in the price. The US government is supporting countries in regions with high HIV prevalence and high levels of drug resistance to introduce and implement this new diagnostic test.

On the treatment side of the equation, the U.S. government is supporting late stage research to test new regimens for multi-drug resistant TB that will reduce the treatment time from 18 to 24 months to 6 to 9 months. Additionally, we are working with global leaders to develop guidelines for the introduction of bedaquiline, the first new anti-TB drug in 50 years, to existing treatment regimens.

EXPOSED: The Race Against Tuberculosis (Official Trailer) from Aeras on Vimeo.

Despite these promising new tools, we need additional point of care TB diagnosis tools and shorter, less toxic regimens to reduce the treatment time even further and with fewer side effects, which can be debilitating for those on treatment for drug-resistant TB. The U.S. government will continue working with global leaders, national TB programs, civil society and at community level to support this critical work in the fight against TB.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

The Promise of MPTs: An Integrated Approach to Women’s Health

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

In recent years, the global community has intensified its focus on women’s health and rights. This reflects a universal recognition that women and girls are fundamental to the health and well-being of societies worldwide — and that we still have significant challenges to overcome before reaching essential development goals.

HIV and maternal mortaility, and their frequent intersection, are  among the greatest obstacles to women’s health and development. Together, they consisitute the two leading causes of death among women of reproductive age.

A woman holding a ring. Photo Credit: USAID

Women are disproportionately affected by HIV/AIDS due to a combination of biology, gender inequality and sociocultural norms. In sub-Saharan Africa, the epicenter of the AIDS epidemic, young women are twice as likely to become infected with HIV as young men.

At the same time, a lack of access to modern contraceptives in developing countries remains a major contributor to global maternal deaths. An estimated 222 million women worldwide want to delay or avoid pregnancy but aren’t using a modern method of family planning. Contraceptives allow women to space and limit their pregnancies,  leading to better health, education and economic outcomes for women and families.

Women in areas with high rates of HIV often have the greatest unmet need for contraception. New multipurpose prevention technologies (MPTs) now being developed address these dual risks, and may give women tools they can use to protect their health and better their lives.

While existing MPTs such as male and female condoms are extremely effective when they can be used, many women cannot negotiate condom use. New MPTs in development — including vaginal gels, long-acting rings and new types of barrier devices — could expand options for discreet, female-initiated prevention methods. In addition, because women’s perceived risk of HIV is low compared to their perceived risk for pregnancy, and given potential stigma around receiving HIV services, combined technologies may be widely used. As such, new MPTs may also help promote increased integration in health care delivery.

With leadership and support from USAID, the International Partnership for Microbicides is applying its experience in HIV prevention to the development of a 60-day MPT vaginal ring that would offer protection against HIV and unintended pregnancy. Now in preclinical stages, the ring would deliver an antiretroviral drug called dapivirine along with the hormonal contraceptive levonorgestrel. Clinical studies are planned for 2014.

The contraceptive field has long taught us that no single product will address women’s unique needs and preferences. While some women may prefer to use a gel around the time of sex, others may find that a longer-acting ring is more convenient and encourages consistent use. USAID is working on a number of new technologies to expand contraceptive options for women and couples across the globe. Learn more about these new contraceptives and multipurpose prevention technologies under development in this slideshow.

While at least several years away, new integrated solutions like these could result in significant health gains for women by reducing rates of HIV transmission, STIs, and maternal and newborn death associated with unintended pregnancies. As a result, MPTs could help advance progress on multiple development goals related to health, poverty and gender equality — and give women and girls a chance to reach their full potential.

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Catching Mosquitoes, Not Fish: Returning Bed Nets to their Proper Use in the DRC

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

It is 1 p.m. in the village of Kavimvira. The sun is high over Lake Tanganyika, at the foot of the Mitumba Mountain, in scenic South Kivu. Frank Baraka has packed the bounty of the morning fishing trip and folded his nets, when his cell phone chimes to signal an incoming text message: : “Sleep every night under an Insecticide-Treated Net (ITN), to protect your family from malaria,” he reads out loud, amused, to his fishing companion.

Frank Baraka sewing a bed net that he will use as a fishing net. Photo Credit: USAID

“This is exactly the message my wife has been pounding at home lately,” Roger Amisi responds. “She says that she heard it at the ETL (Education-Through-Listening) meeting, with Nathalie, you know, the primary school teacher.”

Delaying his lunch, Frank hurries to Nathalie Niéla’s compound to find out about the messages.  “Malaria kills children in our community,” Nathalie says. “Sleep under a net every night, to live safe from malaria,” she confirms.

This is the call to action of the Malaria 3+1 Campaign implemented by USAID’s Democratic Republic of Congo-Integrated Health Project (DRC-IHP), in partnership with C-Change. An estimated 140,949 Congolese from 194 villages were exposed to campaign messages on malaria awareness and prevention. In a country where only five percent of pregnant women receive proper preventive malaria therapy, and malaria accounts for nearly 40 percent of child deaths, prevention is a critical priority.

Nathalie is one of 37 women ETL facilitators recently trained in the DRC-IHP’s field office of Uvira.  “Thanks to ETL, our husbands no longer use the nets to fish or to protect vegetable gardens,” she affirms proudly. “Nets now serve their purpose of protecting children and pregnant women from mosquito bites.”

ETL is one pillar of IHP’s Tuendeni-Kumpala Behavior Change Communication strategy which empowers communities to adopt health-seeking behaviors. Tuendeni-Kumpala which means “moving forward” in Swahili and Tshiluba (two local languages), is an integrated strategy in which ETL facilitators work in synergy with other innovative communication approaches such as mobile technology, to increase the reach and enhance the behavioral impact of project interventions such as malaria prevention and use of reproductive health services.

Through this partnership between USAID, DRC-IHP and C-Change, a total of 64,584 ITNs were distributed across Bukavu, Kolwezi, Uvira, and Kamina, supporting the effort to boost the number of people using insecticide-treated nets.  Campaign results from two health zones point to the value of ETL, in terms of actual ITN use. After four months, 89 percent of the 9,471 households exposed to campaign activities in Uvira slept every night under an ITN.  By contrast, 82 percent of the 12,965 households involved in Kamina (Katanga province) reported adoption of the preventive behavior. When the campaign was launched in June 2012, ETL was not yet rolled out in Kamina.

For the project’s communication team, the difference illustrates the powerful effect of ETL. “ETL truly shows results here,” said Donat Ngoyi, DRC-IHP Communication Expert in Uvira.  “This approach will, no doubt, help us meet our malaria prevention and treatment goals.”

The DRC-Integrated Health Project (DRC-IHP) — a five-year USAID cooperative agreement led by Management Sciences for Health in partnership with the International Rescue Committee, and Overseas Strategic Consulting, Ltd — is strengthening the leadership and governance capacity of people working in the health sector to improve the access, availability, and quality of services within 80 target health zones.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

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