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Archive for the ‘Public Health and Technology’ Category

On November 15th, Maternova, an organization that conducts continuous research into the latest innovations impacting maternal and newborn health, featured the “paperless partogram” on their blog. The blog post explains that for the past thirty years, the partogram has been the recommended practice for preventing prolonged labor in low-resource settings–but it seems that not all health workers find it to be an appropriate tool for the contexts in which they work.

Maternova

“…The partograph is a low-cost tool for saving the lives of mothers and babies. But does that mean it is an appropriate tool? Dr. A. K. Debdas of India would say no. Even after the WHO simplified the partograph model to make it more user-friendly in 2000, the partograph is still rarely used in low-resource areas, and, when actually used, it is rarely interpreted correctly (2). Debdas argues that the WHO’s partograph fails to meet the organization’s own requirements for appropriate technology: the partograph has not been adapted to local needs, is not acceptable to those who use it, and cannot be used given the available resources. Debdas believes the partograph is simply too time-consuming for overburdened clinicians and too complicated for many skilled birth attendants—many of whom have not received higher education.

Dr. Debdas proposes a new, low-skill method for preventing prolonged labor—the paperless partogram. It takes 20 seconds, requires only basic addition and the reading of a clock or watch, and holds potential for more effectively mobilizing clinicians to prevent prolonged labor. Appropriate on all counts…”

Click here to read the full post on the Maternova blog and learn how the “paperless partogram” works!

And while you are on the Maternova site, be sure to check out the Health Innovations page. I found the “Baby Bubbles” and the “Salad Spinner Centrifuge for Anemia” particularly interesting…

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Last week, the Maternal Health Task Force and the Public Health Foundation of India convened a meeting of nearly 700 maternal health experts to discuss lessons learned, neglected issues, and innovative approaches for improving maternal health at the Global Maternal Health Conference in Delhi.

See below for my recap of the first plenary.

The opening plenary, Global progress on maternal health: the numbers and their implications, of the Global Maternal Health Conference 2010 in Delhi focused on global progress on maternal health and explored recent maternal mortality estimates. Speakers discussed the numbers and asked questions not only about what the numbers mean–but also about how the maternal health community can use the numbers.

Over-arching questions from the session were:

Which numbers should we use, those published in the recent Lancet report or those soon to be published by the United Nations (presuming that the numbers will be quite different)?

Will these two sets of numbers prove to be a hurdle in the struggle to bring unity to the global maternal health community? If so, how can we reconcile this and avoid a divide in the community?

Will the two sets of numbers push the maternal health community to establish better and more robust methods of measuring maternal mortality and morbidity?

Has the maternal health community collectively neglected the measurement of maternal morbidity–and how can we begin to focus on measuring not only mortality but morbidity as well?

Brief insights from the opening plenary speeches:

Rafael Lozano, Professor of Global Health at the Institute for Health Metrics and Evaluation, succinctly summarized the  statistical analysis behind the recent Lancet publication in one slide. (Presentations will soon be available online here: www.maternalhealthtaskforce.org/gmhc2010) He also described many of the lessons learned from the research that led to the Lancet piece–the gaining of ground in the reduction of maternal mortality, an improved picture of what the key drivers of progress really are, the correlation between HIV/AIDS and maternal health outcomes, and the importance of communication with countries and local researchers.

Lale Say, Medical Doctor and Epidemiologist at the World Health Organization, discussed the inter-agency approach of monitoring progress on maternal health–stressing the importance of country level consultations and technical collaboration. While she did not present the latest maternal mortality estimates, she talked in depth about the methodology that the World Health Organization, UNICEF, UNFPA, and the World Bank use to estimate global maternal mortality.

Wendy J. Graham, Principal Investigator with Immpact at the University of Aberdeen, urged the maternal health community to understand that failure is not a bad word.  She explained that we often emphasize the successes of our efforts so much so that we neglect to learn from our failures. Wendy also reiterated the importance of context when implementing maternal health programs saying, “context, context, context”–and explaining that because an initiative succeeds in one place, there is no guarantee that it will succeed in the next. We must consider the unique context of each setting where we work.

Saroj Pachauri, Regional Director for South and East Asia at the Population Council, asked a number of thought provoking questions throughout her presentation; We count numbers but do numbers count for policy change? Is there a culture of evidence-based programming? How can we address measurement challenges and improve the use of information? Saroj also noted staggering inequities in maternal deaths between and within countries. She explained that the lifetime risk of maternal death in South Asia is 1 in 43 compared to 1 in 30,000 in Sweden–citing this as an example of a failure to bridge the divide between rich and poor.

For more posts about the Global Maternal Health Conference, click here.

Visit the conference site for archived videos.

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In my last few weeks at the Maternal Health Task Force, I have been working with Raji Mohanam, Knowledge Management Specialist at the MHTF, Matthew Meschery, Director of Digital Initiatives at ITVS, and Lisa Russell, Filmmaker and Co-Founder of MDGFive.com, and an incredible team of presenters, to coordinate a panel presentation on digital tools for maternal health for the Global Maternal Health Conference in Delhi. Take a look below for a post I wrote for the MHTF Blog about the upcoming panel session–with info on how to participate remotely.

I am off to India tomorrow! Check back next week for posts from the conference.

The upcoming Global Maternal Health Conference in Delhi (August 30th-September 1st) will focus on lessons learned, neglected issues, and innovative approaches to reducing maternal mortality and morbidity. The anticipated outcome of the conference is increased consensus around the evidence, programs and advocacy needed to reduce preventable maternal mortality and morbidity.

One session, Maternal Health Digital, will showcase a number of digital communication tools being applied to maternal health. Matthew Meschery, Director of Digital Initiatives at the Independent Television Service, will moderate the session—and will guide panelists and participants through a lively discussion that will explore the potential of digital tools to improve the health of women around the world. Panelists will also address questions about how to measure the impact of such projects.

Throughout the session, conference participants will learn about an email help desk that is aiming to increase access to misoprostol and mifepristine, a mobile phone and radio initiative that is aiming to improve delivery of maternal and neonatal health services, an online media “mash-up” tool that is enabling users to make their own advocacy videos, a crowd-sourcing project that is tapping into the knowledge of front-line maternal health care providers in 9 languages, and more.

This exciting session will include presentations from Google.orgWomen on WebZMQ Software SystemsHealth ChildMDGFive.com, the Social Media Research Foundation, the Pulitzer Center for Crisis ReportingUniversity of Oxford, the Maternal Health Task Force, and the Independent Television Service.

Take a look at the session summary:

In recent years, the health, technology, and communication sectors have come together to innovate health communications through the use of digital media. Advances in tools for cross-media storytelling, social networking, digital games, real-time messaging, and mobile and location-aware technologies are being adapted to fit the needs of the maternal health community—and are helping to fuel the increased momentum around the issue. In this interactive session, conference participants will learn about a diverse range of innovative projects that are aiming to identify challenges and solutions for providing care to pregnant women, build stronger connections among maternal health organizations, create new ways to collect and use data, foster increased collaboration through engaging communities, and continue to drive attention toward the issue. As well as highlighting the promise of these new tools, we will also look at some specific challenges such as measuring impact, working in areas with limited connectivity, and merging online and offline strategies. There will be a series of mini-presentations on crowd-sourcing, interactive mapping, a media mash-up tool, an online reporting hub, mobile health campaigns, and more. Participants will not only get an over-view of a wide variety of strategies and recent developments in digital health communications—but they will also learn tips for applying many of these new tools to their own work and engage in a dialogue around how to maximize the utility of these technologies in order to significantly improve the health of women around the world.

This session will be live streamed! Click here for the live stream schedule.

Join the discussion via Twitter! Conference hashtag: #GMHC2010, Session hashtag: #GMHC2010Digital


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Health officials in the state of Bihar, India have decided to develop a computer software/database that will track expecting mothers, new mothers, and newborns at the village level. The goal of the project is to keep a close eye on maternal and infant mortality in each and every village in Bihar–as well as share important health information via SMS.

iGovernment

“In a bid to minimise maternal and infant mortality in the state, the Bihar government has decided to create a database of each pregnant woman and newborn babies at village level to track their health conditions and provide prenatal and postpartum care to mothers.

The data base would offer unique named-based searches on mother and children.

The data will include date of vaccination and expected date of delivery of pregnant woman. If the family of the expecting mother has any cell phone, they would be informed through SMS. In all 80,797 anganwadi sevikas across the state have been involved to make the campaign a success.

The decision to create software to track the health conditions of expecting women and infants was taken at a meeting of senior officials of the Health Department…”

Read the full story. For more on this story from FIGO, click here.

More on maternal health in Bihar:

  1. Click here to read about a recent agreement between the state government of Bihar and the Bill and Melinda Gates Foundation in an effort to boost the public health of the state.
  2. Click here to read about PRACHAR, a Pathfinder International project that aims to disseminate family planning and reproductive health behavior change communications messages throughout 700 villages in Bihar.
  3. Click here for a recent post on conditional cash transfers to increase in-facility births in many states, including Bihar.

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I learned about a great resource yesterday for those working to improve the lives of women and girls, Girls Discovered: Global Maps of Adolescent Girls. The website has three main sections: Maps and Data, Sunita’s Story, and Take Action. The project is a collaborative effort of the Coalition for Adolescent Girls and Maplecroft.

The Maps and Data section has a nearly endless number of interactive maps and data sets focused on adolescent girls around the world across a number of health, education, social, economic, and population indices. Several of the maps provide interesting information about maternal health or issues impacting maternal health around the world–such as abortion legalizationage specific fertility, global anemia rates, births attended by skilled personnel, and several more.

Sunita’s Story seamlessly combines photos and narrative with maps and data to tell the personal story of one girl in India, Sunita–while also presenting the national burden and geographic distribution of the issues that she faces throughout her life. The presentation is simple and clean, making the information easy to consume.

The Take Action section has three PDF downloadable plans for taking action to address the issues of adolescent girls that are mapped on this site. There is a global action plan, a national action plan for India, and local action plan for India.

I encourage you to explore the site–it is a remarkable resource for those working on any of the various issues impacting adolescent girls and young women around the world.

Description of the project:

“The welfare of adolescent girls is crucial in determining economic and social outcomes for countries today, and in the future. For girls to become healthy mothers, productive citizens and economic contributors, their unique needs must be seen and understood.

Yet today, adolescent girls are undercounted and so underserved. Counting them is the first step to increasing their visibility.

Girls Discovered takes that first step. As a comprehensive source of maps and data on the status of adolescent girls worldwide, Girls Discovered helps donors, policy makers and implementing agencies target their investments.

This one-stop shop for information on adolescent girls is sourced from organizations operating in the public interest, and is meant for researchers, practitioners, advocates, policy-makers and the public – anyone who seeks change for the world’s 600 million adolescent girls.”

Mapping for Maternal Health:

A number of organizations have recently started using mapping technologies to provide visual representation of research and data while others are using mapping tools to link organizations working in maternal health in an effort to build a stronger and more interconnected community of maternal health professionals.

Take a look at a few of the maternal health maps I have visited recently.  Several are interactive and allow for user-generated content!

If you know of other maternal health mapping initiatives, please let me know in the comments section of this post!

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The application process is now closed for this position. (7/22/10)

The Safe Motherhood Program at UCSF is accepting applications for an upcoming internship opportunity in the Copper-belt of Zambia. The intern(s) (2 or more interns are needed) will support the start-up of a randomized control trial of the Non-pneumatic Anti-Shock Garment (NASG) in 24 midwifery-led clinics as a low-tech and low-cost life-saving method for treating shock, resuscitating, stabilizing and preventing further bleeding in women with obstetric hemorrhage.

See below for background information on the Safe Motherhood Program and the use of the NASG–as well as details on the internship including expected deliverables, qualifications, timeline, and information on how to apply.

Background

The mission of Safe Motherhood Program at the University of California, San Francisco, is to prevent maternal deaths by promoting women’s health and human rights.   This international research program is part of the UCSF Bixby Center for Global Reproductive Health, which engages in the advancement of new reproductive health technologies and development of innovative programs to improve reproductive health.  The Safe Motherhood Program is also a member of the Women’s Health and Empowerment Center of Expertise (COE), one of three centers within the University of California Global Health Institute.  The primary goals of the Safe Motherhood Program are to:

  1. Conduct rigorous, relevant and timely research resulting in new and applicable knowledge
  2. Reduce pregnancy related death and disability
  3. Ensure maternal survival through principles of respect, dignity and equality
  4. Create direct and practical links from research to policy to implementation
  5. Train health care workers in low-resource settings
  6. Raise community awareness of maternal health
  7. Disseminate information and innovations globally

Working with distinguished colleagues in a variety of countries, the Safe Motherhood Program has the knowledge, skills, vision, technology, and energy to make a real difference in the advancement of women’s reproductive health throughout the world.

Non-pneumatic Anti-Shock Garment (NASG)

In many poor countries women deliver at home, often without skilled attendants or at clinics with limited services available.  If complications arise and a woman bleeds heavily, one, two or all of the “three delays” (Thaddeus and Maine, 1994) may impede her ability to access timely treatment.  Many women do not survive these delays.  In recognition of the direct and indirect root causes of maternal death and disability, the Safe Motherhood Program works to ensure all women have an equitable opportunity to survive childbirth.

A major research effort of the Safe Motherhood Program, the NASG is a low-technology and low cost life-saving device used to treat shock, resuscitate, stabilize and prevent further bleeding in women with obstetric hemorrhage (www.lifewraps.org).  Use of the NASG as part of standard management of shock and hemorrhage has demonstrated promising outcomes for women in low-resource settings, where appropriate health care providers and technologies are limited or non-existent.  To date, NASG use has reduced maternal mortality and morbidity by over 50%.

Internship Opportunity

To build upon the early and promising data, a randomized cluster trial is underway in Zambia and Zimbabwe.  Specifically, the trial addresses the question of whether the early application of the NASG at midwife-led maternity clinics, before transport to a Referral Hospital, will decrease maternal mortality and morbidity.

The internship will take place in the Copper-belt of Zambia and support the start-up of the randomized control trial of the NASG in 24 midwifery-led maternity clinics.  The intern(s) (2 or more interns are needed) will work with the clinics during their transition from Phase 2 study (women with obstetrical complications transported to referral facility) to Phase 3 of the research study (women with obstetrical complications transported to referral facility in the NASG).  Specific activities will include: Observing clinical procedures at the clinics and supporting clinical protocol adherence, observing data collection and supporting research protocol adherence, helping/training data collectors become familiar with data collection forms, matching data collection forms begun at the clinic with data collection forms completed at the referral facilities, supervising cleaning and completion of data collection forms, and training new providers (midwives, residents, medical officers) in the addition of the NASG to emergency response for hemorrhage.

The intern(s) will receive mentorship and supervision from the Safe Motherhood team members both in Zambia and in the US during the field experience.

Deliverables

Weekly reports on progress, participation in weekly calls/Skype with Project Coordinator are expected.

Qualifications

  • Professional degree, graduate student or junior faculty in the health or social sciences (such as medicine, nursing, public health, anthropology, sociology, etc.)
  • Previous experience in health or social science research
  • Knowledge of global sexual and reproductive health, maternal health preferred
  • Ability to work well with partners
  • Flexibility and willingness to travel
  • Highest preference for those with some midwifery/obstetric experience or those who have worked on field-based research projects

Timeline

The internship requires a minimum eight-week commitment (Fall 2010 – Winter 2011) to live and work in Zambia.  Preference will be given to applicants who can remain in Zambia longer than 8-weeks.

Expression of Interest

To apply for the internship, please send a current resume and cover letter to Ms. Elizabeth Butrick (ebutrick@globalhealth.ucsf.edu) with copy to Ms. Jennifer Clark (JClark@globalhealth.ucsf.edu) by August 15, 2010.

For more information on the use of the NASG (specifically the LifeWrap), check out a recent guest post from the Director of the Safe Motherhood Project, Suellen Miller, on the Maternal Health Task Force‘s new MedScape blog, GlobalMama. (You will need to register with MedScape. Registration is free.)

Also, take a look at www.lifewrap.org for additional information about LifeWraps.

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I was recently selected as a Clinton Fellow in maternal health with the American India Foundation which means I will be moving to India in September to work on the ground on a maternal and neonatal health project! This also means that my position with the Maternal Health Task Force at EngenderHealth will be open as of September.*

So…if you have a background in public health, gender studies, or a related field, are interested in using web-based communications tools, and are passionate about improving global maternal health–take a look at this job at the Maternal Health Task Force at EngenderHealth in New York City!

Job Summary:

“The Knowledge Management (KM) unit of the Maternal Health Task Force (MHTF) requires a highly motivated KM Assistant to help coordinate and implement the MHTF KM strategy and tactics. The KM Assistant will work closely with the KM Specialist in making its online knowledge portal robust, relevant, engaging, and user-friendly. The KM Assistant will proactively identify ways to engage current members and expand our audience.  This position provides a unique opportunity for those who are interested in how technology can help advance MDG5 goals.”

For more information about the job and to apply, click here.

Please feel free to contact me with questions about the position.

*While, I will be leaving my position with the Maternal Health Task Force, I will continue to maintain Maternal Mortality Daily throughout my fellowship in India—in fact, I have  exciting plans for adding new features to the blog over the next few months so stay tuned!

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