New and underutilised technologies to reduce maternal mortality and morbidity: what progress have we made since Bellagio 2003?

In 2003, maternal health experts met in Bellagio, to consider new and underutilised technologies vital to pregnancy-related health services in low-resource settings. Five years later, we examine what progress has been made and what new opportunities may be on the horizon. Based on a review of literature and consultation with experts, we consider technologies addressing the five leading causes of maternal mortality: postpartum haemorrhage, eclampsia, obstructed labour, puerperal sepsis, and unsafe abortion (pregnancy termination and miscarriage). In addition, we consider technologies related to obstetric fistula, which has received more attention in recent years.

Validation of accuracy and community acceptance of the BIRTHweigh III scale for categorizing newborn weight in rural India.

OBJECTIVE: To determine the accuracy and acceptability of a handheld scale prototype designed for nonliterate users to classify newborns into three weight categories (>or=2,500 g; 2,000 to 2,499 g; and <2,000 g). STUDY DESIGN: Weights of 1,100 newborns in Uttar Pradesh, India, were measured on the test scale and validated against a gold standard. Mothers, family members and community health stakeholders were interviewed to assess the acceptability of the test scale. RESULT: The test scale was highly sensitive and specific at classifying newborn weight (normal weight: 95.3 and 96.3%, respectively; low birth weight: 90.4 and 99.2%, respectively; very low birth weight: 91.7 and 98.4%, respectively). It was the overall agreement of the community that the test scale was more practical and easier to interpret than the gold standard. CONCLUSION: The BIRTHweigh III scale accurately identifies low birth weight and very low birth weight newborns to target weight-specific interventions. The scale is extremely practical and useful for resource-poor settings, especially those with low levels of literacy.

Identification of the odour and chemical composition of alumina refinery air emissions.

Alcoa World Alumina Australia has undertaken comprehensive air emissions monitoring aimed at characterising and quantifying the complete range of emissions to the atmosphere from Bayer refining of alumina at its Western Australian refineries. To the best of our knowledge, this project represents the most complete air emissions inventory of a Bayer refinery conducted in the worldwide alumina industry. It adds considerably to knowledge of air emission factors available for use in emissions estimation required under national pollutant release and transfer registers (NPRTs), such as the Toxic Releases Inventory, USA, and the National Pollutant Inventory, Australia. It also allows the preliminary identification of the key chemical components responsible for characteristic alumina refinery odours and the contribution of these components to the quality, or hedonic tone, of the odours. The strength and acceptability of refinery odours to employees and neighbours appears to be dependent upon where and in what proportion the odorous gases have been emitted from the refineries. This paper presents the results of the programme and develops a basis for classifying the odour properties of the key emission sources in the alumina-refining process.

Feasibility and acceptability of gentamicin in the Uniject prefilled injection system for community-based treatment of possible neonatal sepsis: the experience of female community health volunteers in Nepal.

OBJECTIVE: Explore feasibility and acceptability of gentamicin in the Uniject prefilled injection system, in combination with oral cotrimoxazole-p and an appropriate newborn weighing scale, for treatment of possible neonatal sepsis when administered in the community by female community health volunteers. STUDY DESIGN: In a community-based program in Nepal, 45 volunteers recorded 422 live births. Among these, 82 infants were identified as having possible severe bacterial infection. In all, 67 of these infants were treated with gentamicin in Uniject and 15 were referred to the health facility. Mixed methods were used to collect data about Uniject performance, acceptability and safety. RESULT: Volunteers successfully treated 67 infants with gentamicin in Uniject. Gentamicin in Uniject performed well and was acceptable. CONCLUSION: Gentamicin in Uniject, in combination with cotrimoxazole-p and an appropriate newborn weighing scale, is a feasible and acceptable option for treatment of possible neonatal sepsis in the community by female community health volunteers.

Preferences and practices: use of neonatal resuscitation devices in low-resource settings.

BACKGROUND: Birth asphyxia, when a baby does not breathe at birth, is estimated to account for 23% of the approximately four million neonatal deaths that occur annually. Correct use of neonatal resuscitators is critical to lower neonatal mortality rates due to birth asphyxia. METHODS: In order to understand the context of use of resuscitators including use scenarios, training, device readiness and design features and preferences, PATH conducted an anonymous web-based survey among neonatal health experts. Twenty-eight percent (22/80) of experts completed the survey. RESULTS: In general, the bag and mask devices were used by more practitioners and in more places than the tube and mask design; the tube and mask device was not well known. Features of the bag and mask device that mattered most were ease of use, mask size and device function. Features of the tube and mask device that mattered most were ease of use and availability. Device readiness at delivery and use of devices after long periods of inactivity were also concerns. CONCLUSIONS: There was a clear preference for the bag and mask device over the tube and mask device due to its ease of use. Programmatic implications include the need to improve health workers' confidence in the ability of the device to be cleaned and to remain in safe working order over time. These issues should be reviewed during periodic refresher training courses.