Maternal Newborn Child Health

Since 1990, maternal deaths worldwide have dropped by 45 percent, but every day about 800 women die from preventable causes related to pregnancy and childbirth. Almost all of these deaths occur in low-income settings as a result of conditions that include severe bleeding, infection, high blood pressure, and complications during delivery.

Maternal health is closely linked to newborn survival. While great strides have been made in reducing global child mortality, newborns now account for 44 percent of all childhood deaths. Each year, 2.9 million newborns needlessly die within their first month and an additional 2.6 million are stillborn. The main causes, which are preventable and treatable, are complications due to prematurity, complications during delivery, and infection.

Ensuring a healthy population starts with ensuring women of childbearing age and children are taken care of.

Projects

Fihla Ka Nako - Emergency Transport for Pregnant Women and Their Children

It was 3 a.m. Nia was in advanced labour and was about to give birth. Her husband had already contacted the public ambulance service to ask for transport to the hospital. But that had been many hours ago. He had also asked several family members and friends to assist, but none of them had a car available at that time of the morning. The last option was to call a taxi. The taxi driver was on his way to their home in the Tzaneen District. This area, however, had no street lighting, the roads were in poor condition and there were no street signs to navigate by. As a result, the taxi driver took a long time to find Nia’s home, and was not able to transport her to the hospital on time.

 

BABIES BORN BEFORE ARRIVAL

South Africa has no transport policy in place for pregnant women. The ambulance service, including the recently developed system of designated maternity ambulances, is unreliable, too busy, or not yet in operation. The average ambulance response time is between 2 and 3 hours. This is way too long for women in labour who need to go to the hospital right away. According the Medical Research Council, lack of transport is the most common administrative factor leading to high perinatal mortality rates and is also a significant factor in the delays that patients experience when seeking emergency medical care in rural South Africa.

DISRUPTIVE TRANSPORT

In South Africa 113% of the population own a mobile phone and the country enjoys 96% geographic mobile network coverage. Gateway Health Institute developing solutions to provide alternative transport services for pregnant women using mobile technologies. This initiative is called Fihla ka nako (Arrive on time), in short Fihla. Built on the premise of Family Included, all family members, including fathers, will be motivated to sign up for the service. Pregnant women and their extended families, as well as traditional birth attendants, will be empowered in the program to make critical decisions about delivery and danger signs for both mother and baby. This initiative can foster a strong, community-based network. A transport system based on mobile phone technology that enables pregnant women to e-hail a known and trusted driver in emergencies, will make a significant contribution towards ending maternal and newborn deaths.

TECHNOLOGY INVOLVED

USSD technology will be used to reach and interact with all women who own mobile phones. In addition, this initiative will provide USSD messages to motivate for safe pregnancy planning, facilitate behaviour change, and encourage pregnant women and their partners not to delay in seeking skilled care. USSD allows for registration in the database, messaging and interaction. Motivational messages will be sent to women to save a monthly amount towards transport. In order to assist the drivers in reaching the homes of the pregnant women on time, even in the middle of the night, What3Words Technology (W3W) will be used. W3W provides a 3-word address to every pregnant woman in the programme. A mobile app (e.g. navmii) enables drivers to drive directly to the pregnant woman in distress and to the most appropriate health care facilities. Based on a 3-word address, that is linked to GPS coordinates, W3W is a perfect system to locate women in remote and rural areas.

PILOT GREATER TZANEEN

First, the technology will be tested. During the pilot, lessons will be drawn from how the service resonates with pregnant women in the Greater Tzaneen Sub-District and its surrounding rural areas of Limpopo province (South Africa). Greater Tzaneen has a large rural population; almost half of households are female led. The maternal mortality rates, inpatient early neonatal death rates and still birth rates are similar to the national average of South Africa. Gateway has partnerships and support in the Greater Tzaneen Sub-District with access to 72 Community Health Workers, a good relationship with the District Health Department and the Provincial Government of Limpopo Province. The main objectives of the pilot are: To test how technology can offer an innovative and cost-effective response to the lack of transport for pregnant women and their babies; To test a social enterprise business model for viability, feasibility and sustainability; To test the transport service for acceptability and cost efficiency.

SUSTAINABILITY

The program sustainability is hinged upon

  1. Willingness to pay – because we have GPS location through the what3words addressing system we can determine the transport cost upon beneficiary registration in our database and send motivational messages on exactly the amount of money that needs to be saved monthly towards transport.
  2. Stokvels or community savings schemes will be involved in setting up savings schemes for pregnant mothers. Through this we will also develop a community transport plan. Through this, pregnant women can access funds to pay for transport when in need.
  3. Paid for survey services offered to other organizations and institutions who wishes to collect data from our subscribers.
  4. 20% of the transport fee is re-invested in the Fihla social enterprise.

 


 

South African Civil Society Organization for Women's, Adolescent's and Children's Health (SACSoWACH)

SACSOWACH is a coalition of 22 organizations working together to advocate for newborn, child, adolescent, women’s and maternal health.

The main purpose of the South African Civil Society for Women's Adolescent's and Children's Health - SACSoWACH Coalition - is advocacy for the health of newborns, children, adolescents, women and mothers. In this respect to increase public and relevant sector’s awareness, raise the profile and political attention, influence relevant policies, legal, political and social changes and hold government, health providers and others to account for the commitments made to women, adolescents and children.

Focus Areas:

1. Promote, protect and support breastfeeding

2. Adolescent Sexual and Reproductive Health & Rights

3. Early Childhood Development

Members

Gateway to Early Childhood Development

GHI is working towards accreditation with ETDP SETA as Primary ETQA

We will focus on Special Needs ECD for children with HIV and those with learning disabilities.


Amoxicillin R&D

Producing an oil based amoxicillin suspension that remains stable at high temperatures of 40 to 50 °C  for up to two years, eliminating the need for reconstitution of amoxicillin with water, enabling timely and safe treatment of Pneumonia in Children.

The aim is to produce an oil based delivery method of Amoxicillin that can be orally administered to infants and small children, that does not require cold chain, that remains chemically stable  and retains therapeutic efficacy and safety at very high temperatures, such as experienced in some parts of the world, and also retains stability when exposed to direct sunlight. 922 000 Children under 5 died from Pneumonia in 2015, most of them under two years old. Our project, when completed, will put us in a position to save most of them.

 

THE INNOVATION

The B-lactam ring (chemical bond) of Amoxicillin and other Beta Lactam antibiotics is hydrolyzed (broken) by water which causes the quick degradation of amoxicillin reconstituted with water, usually within 2 weeks.  Chemically it is acceptable hypothesis that if water hydrolyses a substance, oil will not.  It is further hypothesized that the product will remain stable for a long time (up to 2 years) with its therapeutic efficacy remaining intact. The risk of using contaminated water to reconstitute Amoxicillin powder is high.  An oil based delivery method will eliminate contamination risks from water.  Contamination risk will further be curbed with individual doses packaged in easy to use ampoules for oral delivery.

Since Amoxicillin is an existing API (Active Pharmaceutical Ingredient), specified limits exists to which our product can be compared. Our product will be a bioequivalent and data obtained should remain inside all current Amoxicillin specifications and within labeled potency parameters.

METHOD AND TESTING

 Mixtures of non-volatile vegetable or animal derived oils, triglycerides such as Mygliol ™  812, silicon dioxide and amoxicillin will be produced and tested.  In the pharmaceutical industry, silicon dioxide has many uses and is generally recognized as safe by the FDA.  Miglyol® 812 is a triglyceride that is a neutral oil of fractionated coconut fatty acids, is known for a wide variety of pharmaceutical applications and remains liquid at 0 °C. Flavorings can be added to enhance the taste, however, even without extra flavorings the drug delivery system in administrable form should be palatable.  Exact data will be collected on the ratios that give the desired viscosity and amoxicillin concentrations.  Initially the product will be produced with Amoxicillin concentrations of 125mg and 250mg per 5ml solution (for effective dosing).  End product with the desired viscosity (to enable oral dosing in children and infants) will then be chosen for stability testing and packaged in clear and amber ampoules. 


Local Organising Committee of the 2nd World Breastfeeding Conference

GHI is a the Civil Society representative on the LOC and also a member of the Program Coordinating Committee. The 2nd WBC will take place in Johannesburg from 11 to 14 December 2016.

 


SmartParent

ACCESS AT YOUR FINGERTIPS

SmartParent goes beyond providing information, education and communication services to parents of babies younger than 2 years old. It is also targeted at fathers and caregivers to increase their involvement and spousal support. It solves issues related to location, by documenting exact GPS address through what3word technology it provides for better follow up care and tracing, provides for privacy and confidentiality by using USSD technology that does not store messaging on the user’s phone, and focus on breastfeeding rather than HIV positive status to decrease stigma and discrimination.

Reasons for not adhering to ART

The most common reasons for discontinuing ART are travelling; transportation costs; limited information about antiretroviral drugs (ARVs); experiencing side effects; feeling weak/sick; non-disclosure; and having conflicting religious or cultural beliefs; no support from fathers or family.

APPROACH

SmartParent uses an nutrition-based approach rather than a HIV status related approach to avoid perpetuating HIV stigma and discrimination.

HOW DOES IT WORK

If you have ever used the location function of a smartphone to order an UBER or to drop a pin for a friend to find you... If you ever recharged a pay-as-you-go mobile phone... If you ever recorded your voice using your phone... Then you have experienced most elements of SmartParent, which is a combination of mobile phone technology, recorded voice, USSD and a 3-word address that is linked to your exact GPS location. Why USSD? It is menu-driven and works on any kind of mobile phone. Why a 3-word address? Informal settlements and rural areas do not have street addresses and 3 words are easier to remember than GPS coordinates. A 3-word address will make tracing of defaulting mothers on ART easier and prevent them from becoming lost to follow-up. Why voice recordings? Voice mp3s cater for those who are illiterate and cannot read or write short sentences. Why a helpline? A toll-free hepline can will provide evidence-based information to both beneficiaries (mothers, fathers, caregivers) and frontline health workers. Why a buddy system? A breastfeedin and ART treatment buddy can collect art, offer emotional support and assist with tracing defaulting mothers.

WHAT INFORMATION DO WE NEED?

    1. Where are you? Send a please call me to SmartParent and click on the link we send you - we locate your smartphone and assign you a 3-word address.
    2. Who are you? You register in our database and complete your profile.
    3. What are your needs? Tell us your needs and receive information and support.
    4. Tell us what you think. Rate the service you receive from healthcare service providers and help improve the services you receive.

WHAT IF

No money? SmartParent is free/very affordable. No smartphone? A friend with a smartphone can help you register, you can then use your basic feature phone for all future communication.

A UNIQUE APPROACH TO USING TECHNOLOGY

SmartParent uses two existing technologies in an innovative way - USSD (Unstructured Supplementary Service Data) and what3words. It is unique because we can remotely assign a 3-word address and register you in our database. It is different from and better than conventional GPS location services because using words means that non-technical people can discover, understand, remember and share a 3-word address more easily than complicated GPS coordinates. It is more accurate than conventional GPS street-address searches that drop pins in the middle of buildings, rather than at the entrance of buildings. SmartParent has both text and voice capabilities, allowing people who are illiterate to request assistance.

WHAT ABOUT SERVICE PROVIDORS?

Service providers will benefit from a progressive Web App. This App will guide service providers to better counsel mothers on topics of breastfeeding, HIV, ART and mobility. It will also assist providers in tracing LTFU cases due to exact GPS location in the database. Progressive Web App (PWA) is a term used to denote web apps that uses the latest web technologies. Progressive web apps are technically regular web pages (or websites) but can appear to the user like traditional applications or (native) mobile applications. Progressive Web Apps are user experiences that have the reach of the web, and are:

  • Reliable - Load instantly even in uncertain network conditions.
  • Fast - Respond quickly to user interactions
  • Engaging - Feel like a natural app on the device.