Photo by Martin Kharumwa of Save the Children, South Sudan. A seven-month-old child lies on a hospital bed in Bor, South Sudan after being treated for pneumonia.
A COMMENT FROM THE COORDINATOR
Oxygen, antibiotics, diagnostic tools, oh my! This month’s PIN newsletter covers a wide range of topics, all critical to our continued fight to drive child pneumonia deaths to zero. We are excited to share with you some new content, including a featured blog post on the COAST trial, authored by Dr. Kathryn Maitland. Read more about COAST and her team’s exciting work below. Adding to the innovative content highlighted in this month’s newsletter is a Member and Partner Update for the Butterfly iQ Diagnostic Tool, featured in The New York Times as a way to detect early stage pneumonia. Do you have an idea for your own innovation but are still looking for funding? Remember that deadlines for our featured funding opportunities are just around the corner, so be sure to submit your applications by the deadlines listed below. If you’re interested in attending a conference this year, consider The American Thoracic Society (ATS) International Conference or the ASM Microbe 2019 Meeting. Links to register for conferences can be found in the Events section of this newsletter. And last but not least, we have added some fresh pneumonia-related papers to the Publications section. Check them out in the Publications section, but remember that there’s no place like the PIN webpage to find the latest pneumonia publications.
Thank you to Drs. Bill Hausdorff, Grant Mackenzie, Shabir Madhi and Gail Rodgers for their excellent presentations on the latest research around PCV schedules for our PCV and PCV schedules webinar event!
The PIN is looking to feature more member-generated content in our coming newsletters and on our website. Submit your interests for blog authorship, your member updates, and any suggestions or comments to us via the PIN webpage Contact Us field.
DEEP BREATHS: BLOGS FROM PIN MEMBERS
The Children’s Oxygen Administration Strategies Trial
by Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases at Imperial College, London and KEMRI-Wellcome Trust
Although oxygen is a basic element of hospital care, strongly recommended as a life-saving therapy for children with severe pneumonia and specifically for children with hypoxaemia (oxygen saturations, SpO2 less than 90%), the evidence underpinning these recommendations is weak. Yet, many African hospitals lack the facility to measure oxygen saturations (using pulse oximetry) and thus, therapeutic oxygen is often poorly targeted. Furthermore, despite a high demand, there is often very limited resources of oxygen therapy which is both costly (if using bottled oxygen) and erratic (if using oxygen concentrators) as electricity is unreliable. Although oxygen has been used in supportive treatment for a large part of the last century, the recognition of oxygen toxicity as a problem has been relatively recent. Toxicity is related to the concentration of oxygen and length of exposure.
Worldwide, there is an increasing recognition of the harms of oxygen therapy. The evolving literature on its harms has resulted in oxygen no longer being recommended for a number of indications. Thus, there is a justifiable scientific question about whether oxygen can be safely and effectively administered, and results in better outcomes in children with severe pneumonia.
The 2012 World Health Organization recommendations for management indicated that current guidelines were based on very low quality evidence. Key ‘Research Gaps’ identified included large-scale effectiveness trials of improved oxygen systems on outcomes from pneumonia, and clinical studies comparing outcomes when oxygen is given at different thresholds. The COAST trial has been designed to address both of these questions simultaneously.
The COAST trial is being conducted in 4,200 children aged between 28 days and 12 years presenting to 4 hospitals in Uganda and Kenya with clinical symptoms of pneumonia complicated by hypoxaemia (defined as SpO2 <92%). The trial aims to establish whether oxygen given to children with SpO2 ≥80% reduces mortality (at 48 hours, the primary endpoint, and up to 28 days, a secondary endpoint) compared with a strategy that includes permissive hypoxaemia. In addition, the trial aims to establish whether use of high flow oxygen delivery by OptiFlowTM (AirVO 2 donated to the trial by Fisher and Paykel) will decrease mortality compared to oxygen by low flow delivery methods (standard care) to all children with hypoxaemia (SpO2 <92%).
We hypothesize that giving an air/oxygen mixture delivered by AirVO 2 will reduce the work of breathing, and ultimately respiratory failure in critically sick children with limited access to mechanical ventilation which occurs in the majority of hospitals in Africa. The trial is collecting information on the costs of each of the interventions which will be of benefit to policy makers as they aim to inform future costs for widespread implementation.
The trial started in February 2017. The trial protocol is available to be downloaded on Wellcome Open (DOI: 10.12688/wellcomeopenres.12747.2).
Sponsor: Imperial College of London
Donation of AirVO 2 and consumables: Fisher & Paykel Healthcare
Funders: Medical Research Council (MRC)
UK Aid Direct
About the author: Kathryn Maitland is a professor of Paediatric Tropical Infectious Diseases at the Faculty of Medicine and Director of the ICCARE Centre at the Global Centre of Health Innovation, Imperial College, London and an Honorary Fellow at MRC Clinical Trials Unit, University College, London. Over the last 18 years, she has been based full-time in East Africa where she leads a research group who have highlighted the unique importance of emergency-care research as a highly targeted and cost-effective means of tackling childhood mortality in resource-limited sub- Saharan African hospitals.
PNEUMONIA INNOVATIONS NETWORK MEMBER AND PARTNER UPDATES
New York Times Releases Article Introducing Butterfly iQ As Diagnostic Tool For Early Stage Pneumonia
The New York Times has just published an article featuring a new and exciting pneumonia diagnostic tool: Butterfly iQ. The Butterfly iQ scanners are primarily used to check for pneumonia, which is a major killer of children in poor countries and is frequently misdiagnosed. However, Dr. Cherniak and his team have found other exciting uses for the device.
"The Butterfly is about the size of an electric shaver. It is battery-powered and contains microchips rather than piezoelectric crystals, so it usually won’t break if dropped. (That was accidentally tested a few times during a week that a reporter spent in rural Uganda with Dr. Cherniak’s team.)
For Butterfly Network, the Connecticut company that makes it, the profitable target customers are doctors and nurses who can afford a $2,000 device that fits in a coat pocket and is as portable as a stethoscope. But the scanner also has huge potential in rural Africa, Asia and Latin America, where the nearest X-ray machine may be hours away and the only CT and MRI scanners may be in the nation’s capital."
Read the full article, authored by Donald G. McNeil Jr, here
The Center For Disease Dynamics, Economics & Policy: Access Barriers to Antibiotics
Isabel Frost, Jess Craig, Jyoti Joshi, and Ramanan Laxminarayan: "In this report, researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) conducted stakeholder interviews in Uganda, India, and Germany, and literature reviews to identify key access barriers to antibiotics in low-, middle-, and high-income countries.
The report makes several recommendations proposing action on antibiotic and diagnostics research and development, strengthening regulatory capacities, encouraging the development and diversification of quality local manufacturing, exploring innovative funding to reduce out-of-pockets payments, raising awareness, and improving clinical treatment guidelines.
Researchers found that health facilities in many low- and middle-income countries are substandard and lack staff who are properly trained in administering antibiotics. In Uganda, 10 to 54 percent of health staff posts are unfilled because of poor pay, high stress, lack of resources, and poor management. Staffing on wards is inadequate to administer medicines, patients miss antibiotic doses, and public nurses sometimes request compensation for administering medicines. In India, there is one government doctor for every 10,189 people (the World Health Organization [WHO] recommends a ratio of 1:1,000), or a deficit of 600,000 doctors, and the nurse:patient ratio is 1:483, implying a shortage of 2 million nurses."
Pneumonia Innovations Network Co-Chair, Leith Greenslade, also comments, "Data like this help to underscore that access gaps are real and deadly."
Access the article here.
Innovation-to-Scale: Call for Proposals
The Global Financing Facility (GFF; www.globalfinancingfacility.org), in partnership with Laerdal Global Health (www.laerdalglobalhealth.com) and the Government of Norway (norad.no/en/), is pleased to announce a Call for Proposals from organizations which can accelerate uptake of proven innovations to reduce maternal and newborn mortality around the time of birth and in the immediate postnatal period. In collaboration with national governments, the goal is to demonstrate and document how accelerated and sustainable delivery of such innovations will help countries achieve the life-saving impacts required to meet ambitious maternal and newborn mortality targets and, through this, facilitate further implementation across relevant GFF countries.
Five grants are expected to be awarded through this call, each with an expected implementation period of three years from inception of activities. Each grant is expected to be up to $5 million, and funding may be provided in multiple tranches.
The deadline for initial proposals is April 30, 2019, at 11:59 Eastern Time. Received proposals will be considered by a review committee established by GFF, and responses will be sent early June, 2019.
Click here to see the full Call for Proposals document.
Apply by April 30: MedTech Conference Global Health Innovator Award
Washington, D.C. March 19, 2019: TEAMFund announced that it is accepting applications through April 30 for its 2019 Global Health Innovator Award. Any and all companies engaged in global health technology research and development are encouraged to apply. This will be the third consecutive year TEAMFund has presented the distinguished Global Health Innovator Award in conjunction with the MedTech Innovator Competition. The award will be presented during The MedTech Conference, Sept. 23-25 in Boston.
The $50,000 award presented by TEAMFund recognizes an early-stage medtech company that has a novel, appropriate and sustainable medical device for the world’s low and resource-constrained populations.
The award is designed to identify efficient ways to accelerate innovation and support the deployment of affordable and appropriate medical technologies in the developing world and other underserved populations. While innovative medical technologies have the potential to impact the lives of patients and health care workers worldwide, significant barriers keep many resource-constrained populations from accessing these technologies.
Want more information about the MedTech Conference? Click here.