Module 15: Innovations in Healthcare for Women and Children

Introduction

In the developed world, much of recent progress in maternal and child health care has been due to highly technical medical interventions, such as newly developed immunizations and prenatal care.  By contrast, maternal and newborn health has seen little improvement in the poorest countries.  In order to address disparities in maternal and child health between the developed and developing world, political and financial commitments are needed to expand access and to develop innovative technologies.

“Improving the health of the poorest people in the developing world depends on the development of many varieties of health innovations, such as new drugs, vaccines, devices, and diagnostic tools, as well as new techniques in process engineering and manufacturing, management approaches, software, and policies in health systems and services.” (1)

Key Innovative Technologies

Improvements are possible through continued innovation in prevention and treatment.  New technological advances in maternal and newborn health show great promise, yet such innovations must also focus on the delivery of life-saving interventions to mothers, newborns, and children in countries where health systems are weak.  Examples of key innovations to address pressing problems in maternal and child health include the following:(2)

• Postpartum hemorrhage: Severe bleeding after delivery—a leading cause of maternal deaths—can now be treated with oxytocin. Oxytocin can be administered by community health workers to women in rural settings using Uniject, a pre-filled, single-use syringe which is being piloted in several countries.

• Infections of the umbilical cord: Infections are very common among infants in developing countries and can be prevented by cleaning the umbilical cord with a solution called chlorhexidine. Trials suggest that chlorhexidine could reduce newborn deaths by one-third.(3)

• Pneumococcal vaccines: Vaccines prevent common forms of pneumonia, the leading vaccine-preventable killer of children under age 5 worldwide.

• Prevention of mother-to-child transmission (PMTCT) of HIV/AIDS: PMTCT can be achieved through the timely administration of antiretroviral treatment to HIV-infected pregnant women and their newborns.

In addition to these proven interventions, several emerging technologies and innovations have the potential to curb morbidity and mortality among women and children.  These include the Rotavirus Vaccine and Safe Delivery Kits.

Rotavirus Vaccines  

A simple vaccination can prevent Rotavirus, the most common cause of diarrhea which causes about 500,000 deaths and two million hospitalizations among children each year.(4)  Many cases of diarrhea can be prevented through improved sanitation, or treated with simple oral rehydration therapy, but rotavirus is not always responsive to these traditional measures. The virus is so contagious and resilient that traditional hygiene measures—such as hand washing and clean water—do not work well enough.  Furthermore, rotavirus infection often causes vomiting, which makes oral rehydration therapy far less effective.  For these reasons, vaccination is the best hope for saving the lives of children in the developing world.  

Unfortunately, rotavirus vaccines are not yet readily accessible to those in resources-poor settings for a variety of reasons, including lack of health care infrastructure and the cost of vaccination.  Although the manufacturers of existing rotavirus vaccines can meet demand over the next few years, new vaccines and suppliers will be essential to keep pace with the market as it continues to grow and to reach areas in which health care delivery lines are not well established.  In addition to increasing available supply, new vaccines mean more competition, which will help bring down cost and make the rotavirus vaccines more affordable.

Today, nearly every child in the world contracts rotavirus before the age of three, but more than 85% of rotavirus-related deaths occur in the developing world.(5)  By accelerating the development of vaccine candidates, organizations can provide children in poor countries with the protection that is already available to children in wealthier ones.

Clean-Delivery Kits

In wealthy countries, having a baby is rarely viewed as a life-risking proposition. The risk of a woman dying from pregnancy or childbirth is 1 in 8,000 in developed countries.  However, in poor countries, that risk can be as great as 1 in 17, and infection is a leading cause of these deaths.  About 57 million women a year give birth without the help of a trained health worker, and often at home, where the risk of infection is high.  Moreover, nearly a million of their newborns die from infection each year as well.

The organization PATH is working to make sure that mothers have a healthy environment in which to give birth, ways to avoid problems such as mother-to-child transmission of HIV and postpartum hemorrhage, and early medical attention.   PATH works to provide culturally relevant technologies and interventions that make delivery as healthy and safe as possible, no matter where in the world babies are born.

PATH’s clean-delivery kit is a simple approach to reducing maternal death by avoiding life-threatening infections.  Over the past decade, PATH has helped develop kits in Bangladesh, Egypt, and Nepal. Most kits contain a small bar of soap for washing hands, a plastic sheet to serve as the delivery surface, clean string for tying the umbilical cord, a new razor blade for cutting the cord, and pictorial instructions that illustrate the sequence of delivery events and hand-washing. (6)

Conclusion

Using proven interventions and new tools in a comprehensive manner is essential to improving maternal, newborn, and child health.  Additional funding is also needed to expand access to these innovations. For instance, an estimated additional $10.2 billion is needed annually to achieve Millennium Development Goals 4 and 5.(7)  With renewed financial, political, and creative commitments, these goals can be achieved.

Footnotes

(1) C.M. Morel et al., Health Innovation in Developing Countries to Address Diseases of the Poor, Innovation Strategy Today, 1, 2005, p.1-15.

(2) The Living Proof Project. Progress Towards Maternal, Newborn, and Child Health. Oct. 2009. https://docs.gatesfoundation.org/Documents/progress-towards-maternal-newborn-child-health.pdf.

(3) PATH. Chlorhexidine for Umbilical Cord Care. June 2011. https://www.path.org/resources/chlorhexidine-for-umbilical-cord-care/.

(4) Countdown to 2015 Working Group, Tracking Progress in Maternal, Newborn & Child Survival: The 2008 Report (New York: UNICEF, 2008).

(5) PATH. "Common Virus and Senseless Killer: A Brieifng Paper on Rotavirus." Rotavirus Vaccine Development. https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/sentinel/Rotavirus_briefing_paper_Sept09.pdf.

(6) PATH. "Clean Delivery Kit: A Timeline of PATH's Involvement." https://path.azureedge.net/media/documents/TS_dk_timeline.pdf.

(7) Partnership for Maternal, Newborn and Child Health, "A Global Call for G8 Leaders and Other Donors to Champion Maternal, Newborn and Child Health," press statement, 19 April 2008. https://www.who.int/pmnch/media/news/2008/g8globalcall.pdf.