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Maternal Wrap - A first Aid Postpartum Hemorrhage Belt

The maternal wrap is a first aid device to control postpartum hemorrhage until necessary interventions are carried out.

Photo of Beryl null

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What specific problem(s) are you trying to address?

According to the World Health Organisation Fact Sheet 2014, every day, approximately 800 women die worldwide from preventable causes related to pregnancy and childbirth. In Uganda alone there were 360 maternal deaths per 100,000 live births in 2013 therefore accounting for about 10 deaths hourly However, 54% of women in low-income countries do not have access to skilled care during childbirth worse still, areas affected by humanitarian crises. The long distances from health facilities play a big role in this . The nearest district or referral hospital usually several kilometres away. This greatly impedes access to emergency health care in cases where PPH occurs.

What are some of your unanswered questions about the problem(s) you are working to address?

As we iterate the design of our maternal wrap for suitability, we continue to study the dynamics of postpartum haemorrhage. This is a complicated scenario that can be caused by any number of reasons like uterine atony, a retained placenta or trauma. The cause of the haemorrhage determines the kind of intervention that is required for the mother’s survival. In order for the maternal wrap to be effective, it must not cause more harm to the patient irrespective of the cause of the haemorrhage.

Explain Your Idea

Alek is a 15 year old girl who has suffered the wrath of civil war in South Sudan at an early age. Orphaned by the civil war she is forced to seek shelter at Bidi Bidi refugee camp in Yumbe district in Uganda where she resorts to prostitution. Alek gets pregnant at 16 years of age and is carrying a high risk pregnancy. Nine months later she delivers a baby girl and something goes wrong. It turns out Alek is bleeding profusely in the aftermath of the delivery and she is getting weaker by the hour. Her caretakers realize that there is a problem and have to rush her to the nearest district hospital about 70km away. Barely alive she arrives at the hospital and the doctors immediately discover that she is deep in shock. A few minutes later Alek is pronounced dead! Alek is not alone, she is just 1 of the 10 mothers that die every hour due to postpartum hemorrhage especially in areas that suffer a strain in emergency healthcare like refugee camps.
The maternal wrap is a simple first aid device that is strapped around the hemorrhaging mother when in use to induce uterine contraction thus reduce blood loss and buy time for appropriate interventions especially in situations of delayed emergency healthcare due to reasons like long distances of transportation to a health facility or drug stock-outs. It is predicted to reduce blood loss by up to 60% if used correctly and therefore increase survival rates of at least 3 mothers for every 4 mothers referred due to PPH related complications.

Name the three most important ways that your idea will address your identified problem(s).

1. The maternal wrap will allow women who have been displaced by conflict and are in remote hard to reach areas
2. health facilities or medical camps without appropriate means to handle the condition will be able to refer patients for treatment
3. Any skilled or unskilled attendant will be able to save a mother's life

How is your idea unique?

Interventions such as Active Management of the Third stage of Labour (AMSTL), administration of uterotonic drugs like oxytocin and misoprostol and surgical treatment have led to a reduction in PPH-related deaths. Other interventions include coagulant drugs, use of the balloon tamponade technique and surgical procedures. Similar to our belt, the Non-Pneumatic Anti-Shock Garment (NASG) and External uterine Compression Devices (EACD) are some of the other technological solutions in the research and development stages. However, these devices are considerably more bulky, more expensive, more complex to use and their effectiveness is based on the applier’s strength. Most importantly, some of these interventions like drugs are not readily available in displacement camps but rather at very far off health facilities. Our innovation will be very affordable and its human centred design ensures that its effectiveness is not compromised by either the users’ ignorance or their physical strength.

What are some outstanding concerns or questions that you have regarding your idea?

In order to test our hypothesis, we carried out preliminary rudimentary prototype tests using a locally designed dummy to evaluate reduction in flow rate when the maternal wrap is in use. The test revealed a 61% reduction flow rate. However, in order to generate scientifically accurate experimental results the functionality test will be carried out using a custom made medical simulation mannequin. The results will give us precise determination of the most efficient and safe pressure ranges.

Who are your end users?

Postpartum hemorrhage not only affects the mothers that die due to the condition but also the children that are orphaned and the relatives that are bereaved. The simplistic nature of the design allows it to be used by the most unskilled mother in dilemma or available attendant who recognizes that the mother is over-bleeding in order to reduce blood loss and buy enough time for further interventions. This means that the belt can be owned by any pregnant mother as a precautionary device, by a traditional birth attendant, ambulance services, make shift health camps and nearby health facilities that might need to refer a hemorrhaging mother.

Where will your idea be implemented?

  • Uganda

What is the primary type of emergency setting where your innovation would operate?

  • Prolonged displacement

Tell us more about the emergency setting that you intend to implement in

Natural disasters and armed conflicts are one of the major causes of displacement camps across Africa. The harsh living conditions there increase the risk of deteriorating reproductive health thus increasing maternal mortality. The maternal wrap is a first aid device for emergency control of the situation for mothers who for one reason or another are unable to attain immediate lifesaving interventions as well as all scenarios of delayed access to health services before they get critical.

What is your organization's name?

Knowledge for Change (K4C)

Tell us more about you.

Partnerships include: Medzyn - Design team; Mulago Department of Obstetrics and Gyneocology who has constantly supported the team in reviewing the design of the belt; Resilient Africa Network who continually support the team in design iteration; Uganda Industrial Research Institute to support industrialisation of the project; Makerere University Centre of Excellence for Maternal and Newborn Health Research support implementation of pilot studies.

Organizational Characteristics

  • International/global organization

What is the current scale of your proposed innovation?

  • Still in planning phase and does not exist yet

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • Yes, for more than a year.

Organization Location

Knowledge for Change was registered in UK in 2012 and in Uganda in 2017. For over 8 years, we have been based and working all across Uganda to improve the healthcare services.

What is your organizational status?

  • Registered non-profit, charity, NGO, or community-based organization.

What is the maturity of your innovation?

  • Existing Prototype or Pilot: Tested a part of my solution with users and am iterating.

Website

1. http://knowledge4change.org/latest-news/
2. https://sites.google.com/site/medzyn4/

How has your idea changed based on feedback?

The simplicity of the design was widely welcomed. We were advised to add a massaging component as this is one of the time consuming procedures a nurse has to carry out on a PPH patient. This would help the nurse be able to attend to another patient since they often have to attend to more than 1 patient at a time.

Another key concern of the healthcare professionals was the mode of cleaning since the device is to be used around blood. Our initial design assumed that it could be washed but the users said that is time consuming for their already heavy work load. Therefore we discussed the possible modifications for even easier cleaning like adding a water proof coat/mackintosh that is easily wiped and disinfected.

Concern was also expressed about the 2 peripheries of the wrap that were thought to be be bulky and inconveniencing. We resolved to automate the inflation and attaching a lighter pressure gauge to remove all periphery attachments to the design and make it lighter and ‘sma

Who will implement this idea?

The idea is currently being worked on by 5 part-time volunteers who comprise the core design team (Medzyn team) and 1 full-time long term volunteer (project coordinator). The design work is being carried out in Kampala in partnership with Mulago National Referral hospital and Marie Stopes Clinic. The idea is hosted and will be implemented under K4C operates under 2 directors and currently has 5 long term volunteers that also comprise the executive of the organization. The organization offers preexisting relationships with the health facilities and district health officers in the regions of proposed implementation. The implementation phase will also be supported by Makerere University Centre of Excellence for Maternal and Newborn Health Research for pilot studies.

Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?

During the feedback phase, the feedback received made us rethink our design approach as we understood that we should create what the user needs and not what we think they need. As such, we therefore intend to include midwives and doctors to our design team to create a more appropriate technology. General ideas in the organization can be presented by any of the members and are discussed at meetings and decided upon. Big decisions however are decided upon by the executive members guided by the constitution and articles of association. The organization is non limited by guarantee without share capital and is open to any person willing and able to promote the goals and objectives of K4C physically, economically, and intellectually without political social, racial and religious limitations.

What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?

End users are mainly the new mothers at risk of PPH and the health practitioners. In refugee camps, there is often lack of food and safe drinking water, and poor sanitation all of which increase the risk of deteriorating reproductive health with lack of access to medical services due to limited health infrastructure and a system ill equipped to handle emergency conditions like PPH. In addition the pregnant women in the camp are poor and can’t afford medical services outside the camp.
Systems-level challenges affect the health practitioners like the continuous lack of equipment and drugs and the long bureaucratic processes of requisitioning for them. This forces the health centers to rely heavily on donations from NGO's and other charitable organizations.

Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?

IMPACT; By the year 2022, our aim is to have brought down the number of postpartum hemorrhage associated deaths from 1455 annually in Uganda to only 100 through our intervention
QUESTION; How do we modify the belt to perform better with a more simpler design while bring the cost further down to a level that is universally affordable but still makes economic sense?

What is it that most attracted you to Amplify instead of a more traditional funding model?

Whereas Amplify encourages innovators to develop economically profitable and sustainable solutions to health challenges, their central tenet of supporting solutions that seek to impact the billions of people living in poverty with a a human factor centered solution approach was most involving and attractive. Development of medical technology is a costly venture but when designed for and around the user and their needs, the outcome is appropriate and effective.

Do you intend to implement your Amplify idea in refugee camps / temporary settlements?

  • We aim to implement our Amplify idea in a refugee camp / temporary settlement.

How long have you and your colleagues been working on this idea together?

  • Between 1 and 2 years

How many of your organizations’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?

  • No paid, full-time staff

Is your organization registered in the country you intend to implement your idea in?

  • We are registered in all countries where we plan to implement.

My organization's operational budget for 2016 was:

  • Between $50,000 and $100,000 USD

What do you need the most support with for your innovation?

  • Business Development / Partnerships Support

14 comments

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Comment
Photo of Cymon Kalibwani
Team

Can a facility/attendant really expect to re-use the same unit on several patients if every mother that needs it, has to leave with it?
If this is essentially a unit that can only be deployed once, i'm wary of the cost to the facility to stock up on enough of these units.

Photo of Beryl null
Team

Hallo Cymon,

thank you for the feedback.
We established that each village health team is attached to a health center II and a number of health center II refer to a given health center III and onward. For the moment, we are presuming that with this kind of arrangement there is regular communication across these health centers and respective ambulances or attendants that move across these facilities.
at the moment, our suggestion would be that each facility has at least 3 maternal wraps with the facilities' name clearly labelled. The attendant that goes with the patient is requested o return the wrap to the VHT representative who is usually a neighbor in the village who then returns the wrap or even returned by the ambulance service.
We are redesigning the return loop but this is the most basic way we think it might work.
We are open to your suggestions as well.

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