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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

15 comments

Join the conversation:

Comment
Spam
Photo of Vince Bel
Team

Are young still working on it? Could we get in touch? Contact me on Twitter or LinkedIn or Facebook search for Vincenzo Belpiede

Spam
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.

Spam
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.

Spam
Photo of Fiona
Team

Good concept that seeks to address some of the challenges associated with current alternatives (NASG and uterine tamponade), and one of the key causes of maternal death and severe morbidity from PPH - transfer time to a facility capable of managing the complication. Cost of the device will be one of the main barriers to widespread use. Need to consider whether it will be reusable (ie: look into how the device can be cleaned without affecting performance and condition to ensure infection control - critical for a device which is likely to come into contact with blood.) Also look into how the device gets back to the original facility after the woman is transferred so that it is available for the next mother - consider the whole system. Good luck!

Spam
Photo of Beryl null
Team

Thank youFiona for the feedback. Surely the whole system plays a big role in sustainability of our solution, we shall work on that

Spam
Photo of Beryl null
Team

Hallo Fiona,

We received similar comments with regard to infection control surrounding the use and sharing of the device. The improved the design to make it 2 part whereby the outer dressing of the device is removable and autoclavable or can be wiped with disinfectant or to have the entire device dressed in a water proof or mackintosh material that can be easily wiped and dried for easier reuse.

Do you have any interesting ideas on this??

Spam
Photo of Mulinde Ket
Team

Great idea like it... a few question for the team.
How much would it cost?
Would the mothers in the rural areas afford this?
And does this belt require technical skills to use?

Spam
Photo of Beryl null
Team

Hallo Ket,

Thank you for you feedback.

Looking at the population of the the women in refugee camps, our target buyer is not the mother herself but rather the health care providers like antenatal and post natal clinics, health centres, ambulance services, and make shift medical camps. The current cost is $6 a unit but we believe we can still bring the costs lower through mass production.

However, if a mother can has been told she has a high risk of suffering from PPH wishes to purchase it for safety purposes, it will still be within the affordable range.

The design is simple and will have visual aids and illustrative instructions for use so that in absence of the technical expertise, it can still be applied.

Spam
Photo of OpenIDEO
Team

Hi @Beryl and Team,

We’re excited to share feedback and questions with you from a set of experts that are supporting this Challenge.

We encourage you to think about this feedback as you continue to improve your idea, whether that’s refining it or adding more context. You are welcome to respond in the comments section and/or to incorporate feedback into the text of your idea. Your idea and all associated comments will all be reviewed during the final review process, but all critical information should be in the body of your contribution somewhere.

- We love that you clearly identify the gap and need for a product to fill a big gap in service delivery for new mothers. Great job!
- Clarity on how you intend to integrate the product into currently existing health systems / organizations will help strengthen your idea. Answering concrete questions like "who do you want to buy this product, and how?" will help articulate your goals.
- We're curious to know more about your plan to generate excitement and use of your product by your users (nurses, midwives, birth attendants) and to scale (clinics, health organizations, ministries of health). Is there a teaching/training component to your idea for your product?- We're excited to see how you develop your user's journey in your map. Some exercises to consider are thinking about the mother's experience from labor, birth, hemorrhaging, and beyond. What do health providers experience? This could help give insight into the experiences of the people who would most likely use the postpartum hemorrhage belt, which will ultimately inform the design of the product.
- One of our experts writes, "I would recommend taking a step away from the belt and focusing more on what your users really want in such a product. We find the solutions that are most interesting are those that approach intended users as potential clients, rather than potential beneficiaries. There's no expectation that you should have all the answers, but we'd like to see you asking yourselves the right questions."

Some questions to consider:
-In addition to being functional, what makes this belt desirable to health providers and mothers? How have these end users been engaged in designing it?

In case you missed it, check out this Storytelling Toolkit (ideo.to/OZznV4) for inspiration on crafting strong and compelling stories as well as the recorded Office Hour (ideo.to/Gf1Cs6). Storytelling is an incredibly useful tool to articulate an idea and make it come to life for those reading it. Don’t forget - the last day to make changes to your contribution on the OpenIDEO platform is October 26 at 11:30PM PST.

Have questions? Email us at amplify@ideo.org

We look forward to reading more, and thank you for the important work that you are doing!

Spam
Photo of Beryl null
Team

Thank you for the feedback and this journey’s experience that our team has gone through as we participate in this challenge. It has been mind-opening as it encompasses new approaches to design thinking that are often overlooked but crucial in developing relevant solutions to existing problems.
The Ugandan healthcare system from the grassroots begins with the village health teams at the lowest level which is the communities first point of contact for healthcare concerns, then health centre II, health centre III, health centre IV, district hospitals, regional referral hospitals and National referral hospitals, in order of increasing level of healthcare services provided. Around refugee camps, health care services are often offered by visiting medical camps or village health teams (VHT), health centers II and III.
For the first phase of this implementation of the maternal wrap, the work will be carried out in Northern Uganda, Gulu district which is a region recovering from 20 years of civil war. We intend to partner with NGO’s and charitable organizations, which like Knowledge for Change (K4C), have been working there for years and are already well established at many of the displacement camps in Uganda supporting the health systems. This approach allows the idea to break through to organizations that are open to adapting innovative solutions and quickens the long bureaucratic processes at the ministry of Health because the idea is easier adopted by the ministry if there are signs of progress. These are also easier to work with because they also work at the grassroots. These NGO’s are also most commonly the ones that buy supplies and donations for the VHT and health centers. This would give the maternal wrap a real chance to save a mother’s life. Through these organizations, the maternal wrap distributed at each of these levels. Initially beginning with the village health teams (VHT), health centers II, III and ambulatory services that are the most commonly found nearest to refugee camps in Uganda with each having at least 3 wraps.
We will use a train-the-trainer model of user training for the belt and begin by training the nurses-in charge or on duty at the ward level at the health centers where the wrap is to be implemented, we shall also supply them with trainer kits in addition to user manuals and visual aids for easier training to be done.

Spam
Photo of Denis Mukiibi
Team

This is a bold Idea in the struggle to save mothers at birth, and the fact that the device can be used just by anyone, gives it more practicability and use in the community as a first aid giving technique. However I urge you to look at whether the device can be improved to also detect or have indicators for Postpartum hemorrhage High risk mothers. These can be referred hospital before they slip into terminal blood loss due to PPH.
One of the key problems in LMICs is the distance of referral which is currently, clearly addressed to a good extent in the proposal. But identification of which mothers is at risk is also still a concern... because bleeding after birth is normal but to what extent? How best can we locally detect that a new mother is almost slipping into PPH (about to lose more than 500ml of blood).

If there is a way to incorporate this indicator/detection for high risk mothers to this device, it may be the answer to solve PPH challenges in Africa and LMICs at least in the communities. Otherwise looking forward to seeing this in our health system. GOOD LUCK!!!

Spam
Photo of Beryl null
Team

Thanks Denis,
The team appreciates and has given a lot of thought to your feedback. Regarding your suggestion that the device could be improved to detect PPH high risk mothers, that would obviously be fantastic. However the risk factors for PPH are diverse in terms of how they present. For example prolonged and augmented labour, pre-eclampsia, multiple pregnancy, multiparousity all have unique complexities. Therefore we recommend that the determination of whether an expectant mother is high risk for pph remains a health worker's responsibility. The belt should come in when the mother loses above the 500ml of blood safety limit. Which brings us to the second issue you raised, we think that is a very crucial aspect that must be addressed and we are thinking about it. Currently we do not have a definite solution but we will have it as the project progresses.

Spam
Photo of martha tusabe
Team

glad to see someting like this. it will save so many mothers in our country Uganda. does it need any specialised training for a mother to use it?

Spam
Photo of Beryl null
Team

Thanks Martha,
Definitely some training will be required for the mother before they use the belt. However, it will not be specialised but only basic. The team intended for the device to be so easy to use that even a set of written instructions with visual aids will be sufficient to guide the mother to proper use of the device.

Spam
Photo of OpenIDEO
Team

Hi Beryl and team,

An important reminder, Refinement Phase closes this Thursday, October 26 at 11:30pm PST.

We can only consider complete submissions, so please make sure that you have reviewed the Feedback and Refinement Phase Checklists and answered all of the questions on the platform. Note that we added one more multiple choice question to the end of the form.

If you're having trouble figuring out how to edit your idea, please refer to this guidance: https://docs.google.com/document/u/1/d/e/2PACX-1vQUuV2N-wO8Oy8MysMAza3CbKUA1ZcMenollZjPh4FA0fGgIDcVXwWtEe6CLh36_Wik5AypEHixreFH/pub

Best of luck!