Above photo provided by Professor William Macharia
Potential for improved survival of newborns in sub-Saharan Africa from affordable, non-invasive point-of-care devices By William M Macharia
An estimated 1 million newborns die in sub-Saharan Africa annually, contributing to 50% of all deaths in children under the age of five. Birth asphyxia, neonatal sepsis and pneumonia are common causes of neonatal death. Especially disadvantaged are children of the poor and residents of rural and urban communities largely served by public health facilities with sub-optimal quality of services. The situation is made worse by scarcity of trained manpower (especially nurses to monitor and administer treatment), shortage of essential supplies, and low staff morale from inadequate remuneration. It is no wonder that most countries in the region failed to meet set Millennium Development Goal targets and are set to miss Sustainable Development Goal (SDG) targets unless major changes take place, and soon. A major let down was stagnation of neonatal and maternal mortality rates that has remained high throughout the years. This has to be the focus for new innovative interventions during the SDG era. Kenya Countdown 2015 case study (https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30246-2/fulltext), whose findings were launched by Kenya’s First Lady in April 2016, pointed out the importance of paying more attention to quality of care around birth and services to poor populations.
By evaluating potential innovations that can continuously and noninvasively monitor physiological parameters such as heart rate and respiratory rate in neonates, there is an effort to identify newborns at high risk for death in overcrowded health facilities with low nurse-to-patient ratios. Early diagnosis and management could lead to better clinical outcomes. A team of researchers from Save the Children, University of British Columbia, Aga Khan University, and Pumwani Maternity Hospital in Nairobi are testing two innovations from device developers, EarlySense and Sibel. A reference device verification phase was completed in August, 2019 at Aga Khan University Nairobi (AKU-N) Hospital, and the accuracy phase data collection for the EarlySense monitoring device is currently underway. We expect the Sibel device to be on site for accuracy testing in November. If these initial evaluations demonstrate device success in the well-equipped AKU-N newborn unit facility, testing for clinical feasibility, use and acceptability will then shift to Pumwani, an extremely busy public maternity hospital in Nairobi serving a population of about 5 million with about 90 deliveries daily.
Professor William M Macharia, a consultant paediatrician and clinical epidemiologist, is Associate Dean Research – Medical College and School of Nursing and Midwifery, Aga Khan University. Professor Macharia was previously faculty at University of Nairobi, Department of Paediatrics which he joined after several years of working in rural health facilities in Kenya.