The global health community can count the drastic reduction in maternal and child deaths over the past 25 years as a major public health success. From 1990 to 2015, annual child deaths fell by almost half, from 12.7 million to 5.9 million, while maternal deaths declined from 530,000 to 300,000.
But preventable deaths, predominantly in developing countries, continue. The international community has committed to eliminating them through the post-2015 agenda of the Sustainable Development Goals (SDGs). And according to a new report by PATH (Program for Appropriate Technology in Health), just a handful of innovations could be a huge help in achieving that goal.
The report highlights 11 measures that it says could cut 6.6 million maternal and child deaths in 24 select countries by 2030. Some are surprisingly simple – such as providing women and girls with long-acting contraception so they can control whether and when they have children, and how many. Others require no technology at all, such as “kangaroo mother care,” where a mother holds her naked newborn against her own body.
“Showing the power of innovations excites people,” says Amie Batson, PATH’s chief strategy officer. “These are concrete ways to accomplish audacious goals like ending all preventable maternal and child deaths by 2030, which makes them seem achievable.”
In order of their projected impact, the innovations are:
1) Injectable contraceptives
By far the innovation with the highest impact on both prospective mothers and children, according to PATH, long-acting reversible contraceptives are already popular because of their reliability, safety and reversibility. But they have generally been available only in clinics, so finding ways for more women and girls in low-resource settings to access them is essential. That requires further innovation of the delivery methods. “The big issue is not only about what tools you have,” Batson says, “but what level of health worker can use them, to make them more accessible.” The Sayana Press, for example, packages the injectable contraceptive at the correct dosage, making it simple enough to be administered by community health workers and possibly, depending on the results of current testing, for self-administration.
2) Better respiratory rate monitors and portable pulse oximeters
Pneumonia is the leading cause of infectious death among children under five. To improve diagnosis and treatment of young children, the report says new reliable, easier-to-use detection equipment is needed, along with the effective use of antibiotics. PATH describes two innovations currently in development: a low-cost sensor that monitors body temperature and respiratory rate and transmits data to nearby devices, and a mobile phone attachment to measure blood-oxygen levels.
3) Kangaroo mother care
What began as an intervention targeting premature babies – the combination of skin-to-skin contact between mothers and newborns and breastfeeding – is now being hailed as an innovation. Prolonged chest-to-chest contact immediately after birth improves thermal regulation in newborns and promotes exclusive breastfeeding.
4) Small-scale water treatment
Lack of access to clean water can cause diarrheal disease, the second leading cause of death for children under five. There are chlorinators currently in development that latch on to existing sources and provide safe water for whole communities. This is an example of what Batson describes as “frugal innovation,” coming from developing countries rather than expensive, high-tech R&D labs. The PATH report describes one such chlorinator, developed in India, that automatically treats 8,000 liters of water between refills of the chlorine dispenser without electricity or moving parts, making it both economical and feasible.
A low-cost antiseptic applied to the birth cord stump can significantly reduce the hundreds of thousands of infection-related newborn deaths each year. New, easy-to-use formulations deliver chlorhexidine at a safe and effective 7.1 percent concentration and can be applied at home by family members when mothers are unable to deliver in health facilities.
6) Antimalarial single dose
Almost half the world population is at risk of malaria. Of an estimated 438,000 deaths from the disease globally in 2015, approximately 69 percent were children under five. The report describes a potent, synthetic antimalarial drug candidate that may be effective against artemisinin-resistant strains of malaria and can be completed with a single oral dose. Its roll-out date is 2022.
7) Neonatal resuscitators
One in 10 newborns needs help breathing at birth, but access to resuscitation equipment is limited in many health facilities in developing countries. New low-cost, user-friendly resuscitators in development may help.
8) Uterine balloon tamponade
Post-partum hemorrhage is the leading cause of maternal mortality. Uterine balloon tamponades have been used in economically developed countries for many years to stop bleeding after other first-line methods. But for health workers who can’t get hold of one, tamponades can also be fashioned from a condom tied to a Foley catheter and then inflated with clean water through a syringe and one-way valve. PATH and Sinapi Biomedical, a South African manufacturer, are developing a simple kit with sterilized parts to make an even handier solution.
9) New formulations of Oxytocin
Oxytocin is the first-choice drug to control post-partum hemorrhage, but it requires refrigeration and a trained health professional to administer it by injection. Alternative formulations such as a dissolving tablet or a dry powder administered with a disposable inhaler are in development and predicted to launch in 2022.
10) Fortified rice
An estimated 2 billion people, particularly women and children, suffer from micronutrient deficiency which can lead to delayed cognitive development, weakened immunity, birth defects or death. For children who live in areas where rice is a staple food, rice fortification is a cost-effective, wide-reaching and sustainable way to boost nutrition, says the report.
11) New tools to detect pre-eclampsia
Hypertensive disorders including pre-eclampsia and eclampsia are the second leading cause of maternal mortality. A condition affecting more than one in 20 pregnant women, pre-eclampsia is associated with dangerously high blood pressure and can be difficult to detect. New easy-to-use, low-cost handheld devices for measuring blood pressure and tests for biomarkers that provide an early warning of pre-eclampsia could prevent women from dangerous seizures, injuries and death.
For these innovations to have their projected impact, they would need to be scaled up and made widely available. The report doesn’t go into issues like education challenges and overcoming cultural barriers, but Batson explains that there is still significant work to be done before the solutions on PATH’s list reach everyone who needs them. “Innovations don’t happen by themselves,” she says. “It’s so important that key partners continue to support their identification, the sourcing and development, but also all the data needed to regulate them if the innovation is a technology or [requires] policy approvals.”