Dartmouth Researchers Win Quarter Million Prize to Reduce Neonatal Mortality in Haiti
FOR IMMEDIATE RELEASE: 11/17/2016
Dartmouth Researchers Win Quarter Million Prize to Reduce Neonatal Mortality in Haiti
MIAMI, FL; November 17 – Today, the Children’s Prize Foundation (CPF) announced that it will award the 4th annual Children’s Prize to Drs. Peter Wright and Alka Dev with the Dartmouth-Haiti Partnership (DHP) at Dartmouth College. Under their leadership the $250,000 award will be used to build a model for the reduction of newborn mortality in Haiti. The 30-month project introduces a low-cost, highly effective neonatology service at Hôpital Immaculée Conception (HIC), the referral hospital for the country’s southern region. In doing so, the project will provide critical support of life in acutely low resource settings.
“It was a most pleasant surprise to learn that we had been selected the recipient of the 2016 Children’s Prize,” says Peter F. Wright, MD, a professor of Pediatrics at Dartmouth’s Geisel School of Medicine and staff physician at the Children’s Hospital at Dartmouth-Hitchcock. “We are now equipped with funds that will allow us to roll up our sleeves and work with Haitian colleagues on the lofty but still achievable task ahead. A task that we firmly believe can change the outcomes of so many young lives.”
Serving as a referral hospital for approximately 775,000 people in a rural area, HIC currently has no capacity for neonatal resuscitation or ongoing respiratory support. HIC needs a neonatal team trained to distinguish and identify stillbirths from newborns requiring resuscitation at birth. The winning plan proposes to: 1) introduce neonatal resuscitation; 2) establish a new neonatal service with capacity for Continuous Positive Airway Pressure (CPAP); and 3) train key health staff in neonatology care, creating the opportunity to save more lives.
“HIC receives a lot of pregnant women who are experiencing birth complications,” says Alka Dev, DrPH, a research associate working with Dr. Wright. “Unfortunately delivering at the hospital does not ensure the survival of a newborn, even though the mother may survive. Premature babies can be relatively healthy but die from something manageable like neonatal respiratory distress. This project will allow us to provide training and equipment that are essential for saving the lives of these newborns.”
CPF Founder Ted Caplow remarked, “Dr. Wright's proposal aligns succinctly with the mission of the Children's Prize. It is straightforward, scientific and efficient. Founding a neonatal care unit in a significantly low resource setting will require skilled practitioners armed with a robust and streamlined equipment package to ensure the prize investment is maximized. This proposal includes adding a full-time physician to the hospital community to focus on neonatal care, and we believe the impact will be both substantial and direct, especially in a country with so few doctors and limited access to adequate health facilities."
At the center of the winning project is Sustainable Development Goal (SDG) 3, which puts forth the target to reduce neonatal mortality to 12 per 1,000 live births by 2030. In 2013, there were 6,713 neonatal deaths in Haiti, and nearly 65 percent were related to respiratory distress.
“Achieving SDG 3 for neonatal mortality in Haiti will be challenging and require capacity across the health system,” noted Wright. “By positioning this project at HIC, we will better understand what resources, training and practices are necessary to lower neonatal mortality throughout Haiti.”
The Children’s Prize is an annual competition that will welcome applications again in April 2017.
Contact:
Stephanie Gregg
The Children’s Prize
stephanie@childrensprize.org
727.710.1088
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About the Children’s Prize Foundation
The Children’s Prize Foundation (CPF) thinks like an engineer, placing its strongest emphasis on efficiency and scientific accuracy. The foundation empowers and unites the drive of human competition with the hyper-connectivity of the information age by administering a global, annual contest, the Children’s Prize. This initiative invests in proven child survival work. As a novel philanthropic approach, we insist on a direct link to lives saved for all children under five years of age. The Children’s Prize Winners enter into a collaborative relationship with the CPF to execute their vision. Founded in 2013 by Dr. Ted Caplow, the portfolio of projects includes investments in Pakistan, Nepal, Kenya, Uganda, Angola, Sierra Leone and Haiti. For more information, please visit www.childrensprize.org.
Ready to win the 2016 Children’s Prize? We’d like to help!
Last year we offered our applicants collective observations of issues we saw that prevented them from moving forward in the competition. Many appreciated this generalized feedback, and as we launch the 2016 Children’s Prize, we would like to share these insights to help you improve the quality of your application submission.
As funders, we value the connection between feedback and improvement; our goal is to elevate excellence. While it is impossible to provide the hundreds of Round 1 applicants individual feedback, we feel that the following recommendations apply to a significant majority.
- Thoroughly read the instructions. Make sure you understand the specific purpose of the prize contest itself, as well as each question asked. Make sure you meet the basic criteria required for the competition. If you cannot meet or adequately address it in your proposal, then you probably should reconsider applying. Answer questions directly and concisely. Make sure to sufficiently explain each answer for each question asked.
- Credibility is important. Explicitly state your assumptions. Explain how you arrive at estimates and what evidence/fact/science-based data you use for your assumptions. Describe direct links to any partners or organizations involved with the plan you are proposing.
- Use a solutions-focused approach. Emphasize the proposed solution rather than simply describing the problem.
- Balance cost-effectiveness with introducing novel elements to your work. Funders want to see their money used wisely and effectively. Be clear about the impact you seek to achieve. Think about the overall impact of your proposal in relation to the prize funds. Make the case for why your project should win.
- This may seem like an easy step to skip, but it may one of the most important things you do: Proofread! Invite a different person to proofread the material you plan to submit. This will ensure your application conveys what you intend, while being clear and concise about your plan. This may be especially beneficial for non-native English speakers.
Each round of the Children’s Prize competition serves a specific purpose. The first round is an open call to any person or organization with a ready-to-implement plan that is focused on saving the lives of children under-five from preventable and treatable causes. Given the brevity of the initial application, as well as the quantity of submissions received, applicants will benefit from approaching this round as a funding request “pitch.” Keep in mind that in the second round applicants will provide a more thorough and detailed plan that will include supporting materials such as a budget, timeline and references. Only 10-20% of the initial applicants are selected to participate in the second round.
Additional documents including a Frequently Asked Questions, as well as Prize Guidelines and Privacy Policy, can be found on our website at www.childrensprize.com. We welcome your 2016 Children’s Prize applications and look forward to learning more about your life-saving work!
Meet the 2015 Children’s Prize Finalists
We are proud to announce that from 43 second round submissions, seven were selected as potential candidates for the $250,000 award this year. We invite you to take a moment to review a brief summary of each finalist. From October 23-25, our esteemed panel of judges will convene to deliberate and select the winner of the 2015 Prize. Please stay tuned to Facebook and Twitter in the coming weeks to learn more about the potential impact these life-saving projects propose for children around the world.
Maternova Research: The Omugwo Project
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Country: Nigeria
Under 5 mortality rate in country: 117/1000 live births
Estimated number of lives saved: 2,205
Project Length: 34 months
Highlighting the importance of maternal health in child survival, Maternova Research aims to utilize its partnership with local organization the Traffina Foundation to administer proven rapid tests to pregnant women to assess 10 key diseases, infections and blood disorders that most greatly impact child mortality in Nigeria. They would also implement newborn health interventions to include immediate and exclusive breastfeeding.
Peter Meaney: Saving Children's Lives
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Country: Botswana
Under 5 mortality rate in country: 47/1000 live births
Estimated number of lives saved: 1,247
Project length: 24 months
The Children’s Hospital of Philadelphia partnered with the American Heart Association to create the child survival program, Saving Children’s Lives. Saving Children’s Lives engages community healthcare providers, physicians and nurses through continuous training and competency monitoring to best treat pneumonia and diarrhea, two major contributors to child mortality in Botswana.
Physicians for Social Justice: Yaara Mobile2Mobile Health Project
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Country: Nigeria
Under 5 mortality rate in country: 117/1000 live births
Estimated number of lives saved: 3,702
Project length: 24 months
Physicians for Justice proposes the Yaara Mobile2Mobile Health Project which would increase healthcare access in Mashegu, Nigeria. A three-pronged approach is proposed: 1) using integrated outreach-based Mobile Clinics (MC); 2) deployment of telemedicine (mHealth tools); and 3) establishment of robust Community-based Rapid Response Health Extension Services. To date, Physicians for Justice has implemented 12 health projects in Mashegu.
Project Peanut Butter: Improved Care of Malnutrition
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Country: Sierra Leone
Under 5 mortality rate in country: 156/1,000 live births annually
Estimated number of lives saved: 4,500
Project length: 36 months
Project Peanut Butter (PPB) seeks to treat severe malnutrition in children 6 months to 5 years old by providing affected children with effective, locally produced ready-to-use therapeutic foods (RTUF). Mothers would be given the RUTF to take home and assigned in-clinic visits. PPB will educate the community on how to recognize the signs of malnutrition and how to treat the debilitating condition.
University of British Columbia: Interventions to Radically Reduce Infant Mortality from Sepsis
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Country: Malawi
Under 5 mortality rate in country: 67/1,000 annually
Estimated number of lives saved: 840
Project length: 24 months
UBC would prevent, diagnose and treat neonatal sepsis with a 4-step bundle to include: 1) an educational training program; 2) a tool-kit with chlorhexidine swabs to clean the umbilicus and topical emollient for low birth weight infants to reduce the risk of infection; 3) BCG vaccination at birth; and 4) a mobile diagnostic device to non-invasively and promptly assess a patient’s condition.
University of Miami Department of Pediatrics: Newborn Screening for Hemoglobinopathies
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Country: Haiti
Under 5 mortality rate in country: infant-54.7/1000 and 5 year- 77/1000 live births
Estimated number of lives saved: 60
Project length: 24 months
This project will implement newborn screening for hemoglobinopathies, which can detect sickle cell disease, as a life-saving intervention that is not yet available in Haiti. Newborns would be screened prior to leaving the hospital after birth by trained nurses, and the samples would be assessed in Port-au-Prince.
World Hope International: Saving Lives at Birth
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Country: Sierra Leone
Under 5 mortality rate in country: 156/1000 live births
Estimated number of lives saved: 5,336
Project length: 16 months
World Hope International aims to save children’s lives in Sierra Leone by training 43 chiefdoms in the Helping Babies Breathe curriculum. Developed by the American Academy of Pediatrics, Helping Babies Breathe teaches birth attendants in developing countries critical skills in newborn resuscitation.
2015 Children's Prize Round 1 Proposal Feedback
Dear Applicants:
Many of you requested feedback on your round one proposal submission, and we would like to acknowledge your efforts. Although it is difficult to provide hundreds of applicants detailed and personalized feedback, we would like to take a moment and highlight the most common reasons why applications were unsuccessful in moving forward to the second round. The collective feedback we are providing here is important, and it is intended to emphasize the value we place on the connection between feedback and improvement since our goal, as a funding initiative, is to elevate excellence that will result in more lives saved.
The eight observations below are to assist you in any future prize application writing that you may undertake, and were noted among this year’s proposals:
- In general, we highly recommend that an outside person proofread the material you plan to submit prior to submitting. This will ensure that your application conveys what you intend while being clear and concise on your plan. Also, this may be especially beneficial for non-native English speakers.
- The required criteria for the prize was not adequately addressed and/or met. This includes but is not limited to: the under-five children population was not the primary target, the project population to be served was not clearly stated and specified, the project timeline was too long (3 years and over), lack of a data-oriented approach, and proposal submitted in a language other than English.
- The majority of applicants emphasized the problem significantly rather than the proposed solution. In this case, a solutions-focused approach is highly recommended.
- Lack of clarity, application was too vague when outlining the project plan. There is a difference between a project idea and a project plan that is ready for implementation. Successful applicants were compelling and established clear goals with measurable outcomes.
- There were instances where application questions were not answered directly, sometimes ignored completely or response was insufficient. We suggest that each question be answered as direct as possible.
- There were credibility concerns associated with number estimates, proposing a fact/science based project, and the extent of links to community partners outlined. Although you don’t have to be a doctor or part of a large organization to be considered or be successful in the prize process, credibility remains important.
- Applicants proposed a significantly low overall impact for the prize funds.
- Proposals were experimental or strictly research focused. In general, successful applicants balanced cost-effective approaches while introducing novel elements to their work in serving and saving lives under-five in a data-driven context.
Each round of the Children’s Prize serves a specific purpose. The first round is an open call to any person or entity with a ready-to-implement plan that is focused on saving children under-five from preventable and treatable causes. Given the brevity of the initial application as well as the hundreds of submissions received, the applicant will benefit from approaching the first round as a funding request “pitch.” Creating a solid and concise pitch demonstrates your experience and capability to highlight the most important aspects of your proposed intervention(s) and overall project plan.
The second round, which is by invitation only, will be more thorough and comprehensive. It will include requests for additional material that include a project timeline, budget, references, etc. At this stage, only 20% of the round two applicants will continue the process to the third and finalist round where they will be reviewed by an outside panel of expert judges.
We hope that you will continue to pursue your project plans and that although you have been unsuccessful on this occasion, you found the Children’s Prize application process worthwhile, and can use this feedback to help you make a more effective application in the future. Please note, addressing general feedback provided does not guarantee that a future application will be successful.
Sincerely,
The Children’s Prize Team
International Funding Opportunities
The second round of the 2015 Children's Prize opened Monday, July 13th. With just under 400 proposals submitted, only a small fraction of the applicants (approximately 10%) were invited back to submit a more detailed and comprehensive application. Applicants, we recognize that each proposal is unique in its approach and merit. Therefore, we want to continue recognizing the importance of your work and dedication in ensuring that more children survive. Our team compiled funding opportunities to support your work, see the list below.
Every child health project that receives funding is an opportunity to save more lives, and that’s a win for children everywhere. We wish you all success in your future endeavors!
Child Health
The David and Lucile Packard Foundation: The Children, Families, and Communities Program
The Children, Families, and Communities Program strives to ensure that all children have the opportunity to reach their full potential. Our grantmaking strategies address two interrelated and fundamental needs that must be met for our children to thrive: health and education.
The mission of The Gerber Foundation, to enhance the quality of life of infants and young children in nutrition, care, and development, has remained the guiding beacon for Foundation giving throughout its history. Accordingly, priority is given to projects whose primary beneficiaries are young children from birth to three years of age.
Ronald McDonald House Charities
We are currently in the process of refining our global grant focus to ensure that we advance our mission by reaching children with the greatest needs around the world and ensuring that our resources contribute to impactful and measurable outcomes. During this process, RMHC will not be receiving grant applications from other non-profit organizations. We anticipate the next grant cycle to begin in early 2016.
"to save the greatest number of children's lives at the lowest possible cost."
Guided by the belief that all children should have an equal opportunity to thrive, WKKF works with communities to create conditions for vulnerable children so they can realize their full potential in school, work and life.
Environment
To empower rural and indigenous people to restore and protect tropical ecosystems in Central America and Mexico.
New England Biolabs Foundation
The New England Biolabs Foundation ( NEBF ) is a private independent foundation whose mission is to foster community-based conservation of landscapes and seascapes and the bio-cultural diversity found in these places.
Innovation
Our mission is to strengthen local ecosystems, build leaders and entrepreneurs, and catalyze innovative thinking to accelerate creation of sustainable, scalable enterprises that have significant social and economic impact.
Provides grants and support to a broad range of organizations working to create a more just world. Imago Dei seeks to partner with inspired change-agents working around the world to transform injustice with passion, faith, human solidarity, innovative ideas, effective programming, a collaborative bent, and a shared vision of a better world.
Seeks to make efficient & effective contributions to development in Sub Saharan Africa. We find & fund grassroots innovations that might otherwise be overlooked.
The Global Innovation Fund invests in social innovations that aim to improve the lives and opportunities of millions of people in the developing world.
The Canada Foundation for Innovation (CFI)
The CFI funds leading-edge research projects that build the nation’s capacity to innovate, compete and prosper in a knowledge-based global economy.
Multiple Focus Area
Health Resources and Services Administration (HRSA)
HRSA awards billions of dollars in grants that enable organizations and institutions to help build healthy communities and healthy people.
Focused on scalable solutions to the basic needs of the very poor.
Global team is building a portfolio of projects that delivers measurable improvements in the interconnected areas of livelihoods, health, environment and education, predominantly in rural areas. Investments are currently focused in sub-Saharan Africa, Haiti, and India.
Global Programs focus on the areas of poverty alleviation, health and the environment.
The David Weekley Family Foundation
Works to alleviate global poverty, primarily in the areas of education, health, and financial security. We provide a combination of treasure, time, and talent to help social entrepreneurs reach scale.
A family-to-family philanthropic advisory firm that provides financial and other resources to enhance human rights, improve the lives of women and children, preserve cultural diversity and ensure the environmental health of the planet.
Believes that dedicated, talented leadership is the essence of social change. To this end, DRK Foundation provides funding and business mentoring to social entrepreneurs as they begin their non-profit organizations.
Advancing the human right to land, water and food around the world through strategic grantmaking and advocacy.
Works to bring about the end of suffering (human and non-human) in areas of the highest need. The Foundation seeks and encourages business efficiency and selfless, common sense approaches to the humanitarian world. Organizations are assisted with guidance, networking, and funding.
We advance social change through grantmaking and operational programs.
Provides assistance to the world’s poorest people through the development and support of programs that improve healthcare in developing countries.
Fund entrepreneur led organisations targeting big problem
s with a market-based, impact-driven approach. We currently fund 20 experienced entrepreneurs developing scalable models to provide healthcare, education and improved livelihoods to the world’s most disadvantaged.
The J.C. Flowers Foundation partners with other funding organizations, governments and local grassroots organizations to solve health and social problems. The Foundation seeks maximum impact from its investments by working with a wide range of partners with expertise and presence in hard to reach areas, or “last mile” communities.
JPMorgan Chase works with community partners to create pathways to opportunity by supporting workforce development, financial capability, small business development and community development in the regions where we do business.
Mission is to strengthen youth and families to build lives of dignity and self-reliance. We primarily invest in and serve early to mid-stage social entrepreneurs who are effectively addressing the issues of poverty in the San Francisco Bay Area and around the world.
The Pershing Square Foundation
Invests in organizations that use innovative and scalable solutions to attack the compounding roots of poverty: poor health, injustice, substandard education, economic limitations and isolated communities.
We find and invest in grassroots organizations that enable the most vulnerable children in their communities to thrive.
GlobalGiving is a charity fundraising website that gives social entrepreneurs and non-profits from anywhere in the world a chance to raise the money that they need to improve their communities.
We believe global threats share causes, challenges and, potentially, cures. We primarily seek to identify and address complex challenges common to multiple global threats.
Women: economic empowerment and entrepreneurship
Water: access to clean water, water conservation and recycling
Well-Being: active healthy living, education and youth development
In addition, the Foundation supports many local community programs such as arts and culture, community and economic development programs in the United States, as well as HIV/AIDS prevention and awareness programs in Africa and Latin America.
We specifically focus on programs supporting children, education and health and human services. The United Way, Children's Miracle Network Hospitals and the Red Cross are examples in our charitable giving.
Hasbro has a long and proud tradition of supporting children worldwide through a variety of philanthropic programs. Our mission is to empower childhood by bringing “the sparkle of Hope, the joy of Play and the power of Service” into the lives of the children who need us most.
The Mockingbird Foundation provides funding for music education for children, through competitive grants, emergency-related grants, and tour-related grants.
The Florida Panthers Foundation
The Florida Panthers Foundation supports the children and families of South Florida through partnerships, grants, and community programs that facilitate enhanced fitness, health and education. -Florida Panthers Foundation Mission
Poverty
Ansara Family Fund at the Boston Foundation
Capacity Building to Eradicate Poverty.
Established by Maureen and Tony Wheeler, founders of Lonely Planet Publications to support practical and effective projects which make a difference in the alleviation of poverty. We currently fund over 50 projects in the developing world, mainly in East Africa, Burkina Faso, Afghanistan, Burma, Cambodia and Laos.
Women's Rights
Global Fund for Women makes grants and advocates globally for women’s human rights. We fund, amplify, connect, and sustain women’s organizations and women’s human rights movements, and create digital advocacy campaigns on critical global issues for women and girls.
Environment, climate change & children's health
The Sustainable Development Goals (SDGs) are a set of 17 universal targets that will provide a roadmap for the future of international development. Viewed as a more comprehensive extension to replace the soon to expire Millennium Development Goals (MDGs), the SDGs will be adopted by the United Nations in September 2015. Over the years, the mainstream conversation around the development goals has more markedly emphasized the role of the environment and climate change. These are underlying factors that will dictate the degree of success for the areas these development goals will address - poverty alleviation, improved maternal health and child health, reduced malnutrition, access to clean water, etc. Amongst the ambitious 17 goals you’ll find that Goal 13 emphasizes the need to “Protect the Planet” against the effects of climate change.
 Sustainable Development Goal 13: Protect the Planet. |
At the Children’s Prize, our focus is to advance the survival of children under five. Within the context of environmental impacts and climate change, children are one of the first vulnerable populations that feel the effects of climate change, both directly and indirectly. But what makes children so vulnerable to changes in climate and environmental exposure and susceptible to disease? They have immature immune and central nervous systems that makes them more likely to experience infections and developmental problems. They have little to no control of their environment, generally have a smaller body mass to surface area ratio and require more water and nutrients per unit of weight. Not only can they consume high amounts of toxins and infectious agents, but they are significantly more susceptible to the negative effects of these exposures when compared to adults.
What are some current examples of climate related issues that affect children?
Climate change affects the geographic distribution and life cycle of vector organisms, such as rats and mosquitoes, and pathogens, such as malaria and schistosomiasis. These pathogens disproportionately affect children, especially in low resource countries such as Africa, where a child dies every minute from malaria. Changes in geographic distribution may cause mosquito populations to shift, bringing more malaria to one country while decreasing the malaria in previously affected countries. This could present a major problem, especially if countries are not equipped to handle diseases such as malaria. A lot more children may die as a result.
 On the road in Karachi, Pakistan. |
Agriculture and the availability of crops is a significant source of livelihood in many low resource areas. Mild climatic changes during growing and harvesting seasons can drastically affect crop yields. This can further impact the rates of childhood malnutrition, childhood mortality and morbidity. Childhood malnutrition remains one of the leading causes of death in children under five years of age, worldwide.
Wars and violent conflicts can and have been shown to occur simultaneousness following times of disease, starvation, drought, loss of habitat, and loss of natural resources. Low resources that are further strained by environmental factors, coupled with mass migrations can lead to internal political and social conflicts. Children are some of the first casualties of violence both directly through wounds and indirectly by starvation, dehydration, poor healthcare.
The table below demonstrates some environmental related exposures that have been associated with negative health outcomes in children. Children are highly affected by the physical environment in which they live and breathe.
 Table 1. Impact of climate change on children’s health. Xu, Zhiwei, et al. "Climate change and children’s health—A call for research on what works to protect children." International Journal of Environmental Research and Public Health 9.9 (2012): 3298-3316. |
And as we approach the end of the Millennium Development Goals and transition into the Sustainable Development Goals, we must make take into consideration the direct and indirect effect of climate on children. Newborns, infants and children will be at a greater risk to poor health as a result of climate change. December of 2015 will hopefully mark the date of a historic international collaboration for better health, more sustainability, and a healthier planet. The United Nations Climate Change Conference will be held in Paris, France and under the leadership of Ban Ki-moon will be primarily focused on achieving a binding, universal, agreement on climate. We must ensure that child health is not left out of the discussion and the binding document. The impacts of climate change and environmental hazards on child health are already apparent throughout scientific literature. It's important to act now, the future of child health and global public health in general will be significantly impacted in the years to come.
#Paris2015 #ActOnClimate #COPA12
References:
McMichael, Tony, Hugh Montgomery, and Anthony Costello. "Health risks, present and future, from global climate change." BMJ 344 (2012): e1359.
Sheffield, Perry E., and Philip J. Landrigan. "Global Climate Change and Children as Health: Threats and Strategies for Prevention." Environmental health perspectives 119.3 (2010): 291-298.
Xu, Zhiwei, et al. "Climate change and children’s health—A call for research on what works to protect children." International journal of environmental research and public health 9.9 (2012): 3298-3316.
http://www.theguardian.com/commentisfree/2015/jun/10/dont-care-about-climate-change-what-about-the-health-of-children
Newborn health in rural Nepal benefits from portable ultrasound donation
Sonosite’s portable ultrasound donation is providing life-saving health care to pregnant women and newborns in rural Nepal. Leading this project is Dr. Joanne Katz, Professor and Associate Chair of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. From over 200 project proposals received, Dr. Katz was selected as one of two prize recipients for the 2014 Data for Life initiative which focused on funding interventions aimed at reducing child mortality and scientifically evaluating the impact of their work in saving lives. During a project status call with Dr. Joanne Katz, she enthusiastically shared the story of a Sonosite portable ultrasound donation for her current work in Nepal. Along with Dr. Katz, we at the CappSci Children’s Prize would like to show our gratitude for your generous donation, it supports the advancement of scientific research and maternal and child health. Thank you, Sonosite!
 Auxiliary Nurse Midwife conducting an ultrasound exam during a home visit. Sarlahi, Nepal. |
Dr. Katz and her team are looking at the use of portable ultrasound for expecting mothers in rural Nepal where home births are very common. There are a number of risk factors that appear during the third trimester which can be detected with the help of portable ultrasound machines, allowing women to seek appropriate care and prepare for medical facility-based deliveries. Risk factors such as non-cephalic presentation (e.g. breech births) or multiple births (e.g. twins) require very skilled health workers and also the option of a cesarean section if labor does not progress properly. Trained entry-level auxiliary nurse midwives will use portable ultrasounds to uncover common risk factors during home visits. The goal of the project is to examine the sensitivity and specificity with which the auxiliary nurse midwives are able to detect conditions that may lead to delivery complications as well as compare the early neonatal mortality and stillbirth rates between those who received an ultrasound exam through the study and a separate comparable group.
 Auxiliary Nurse Midwives (ANMs) conduct exam and make home visits in pairs. Sarlahi, Nepal. |
In her own words, Dr. Katz shared the following account on the Sonosite portable ultrasound donation:
Sonosite SoundCaring and Global Health Humanitarian Programs allowed the Nepal Nutrition Intervention Project Sarlahi (NNIPS) in collaboration with Tribhuvan University Institute of Medicine and Johns Hopkins Bloomberg School of Public Health and School of Medicine, to apply for a refurbished portable ultrasound system. This equipment has allowed us to bring ultrasound examinations to rural women in their third trimester of pregnancy to screen for non-cephalic presentation, multiple gestation and placenta previa. Many women in this area of Nepal deliver at home, but even for those who do go to a facility, such facilities may not be able to provide the necessary care for safe delivery for women with these conditions. With support from the CappSci Children’s Prize and a donation of a portable ultrasound system from Sonosite’s SoundCaring program, home ultrasound examinations are being provided to rural women in Sarlahi from Auxiliary Nurse Midwives trained to identify these conditions using the Nanomaxx product from Sonosite. Women with non-cephalic presentation, multiple gestation and placenta previa are told about these conditions and encouraged to seek antenatal care and to present for delivery to a special Emergency Obstetric Care Facility where the providers are best equipped to manage these more complex deliveries.
 Sonosite Nanomaxx product in its carrying case. |
Given the difficult environment in which we operate (extreme heat, dust, humidity, variable electricity and transport of equipment on the back of a motorcycle over rough roads), the equipment has failed us on several occasions. With only one system, home visits have ground to a halt while we hand carry the equipment back to the US for repair or replacement. Sonosite has been incredibly generous in repairing or replacing the equipment each time, but the need for a second piece of equipment became apparent if we wanted to continuously provide service while non-functioning equipment is being repaired. We at Johns Hopkins Schools of Public Health and Medicine wrote to Sonosite to request a donation of a second machine. They have most generously agreed to provide us a second ultrasound system, also the Nanomaxx, to allow us to provide uninterrupted home examinations. The program continues and has examined 480 women through June 24, 2015.
Driving for results: A Q&A with Dr. Anita Zaidi (part 2)
In this two part interview, Dr. Zaidi, the 2013 Children’s Prize Winner, shares the latest from Rehri Goth, Pakistan. The first part of the Q&A can be found here.
Until you established VITAL, many women, following tradition, were having home births even if they needed medical interventions. How has the VITAL helped women who needed medical care choose facility deliveries?
Anita Zaidi: We have worked with the community to raise awareness, through employing influential local men and women to promote safe deliveries. We have also linked Rehri Goth with hospitals providing quality obstetric services, and with emergency transport services, and through a charitable trust hospital, Koohi Goth Hospital, provided ante-natal services through midwives placed in local clinic.
In your proposal you mentioned training programs for women in the community. How will these training programs save more children’s lives in the long run and how likely will it be that they remain in Rehri Goth?
Anita Zaidi: Rehri Goth had only traditional unskilled birth attendants providing birthing services in the area. We thought that an important program legacy would be to train local women to become community midwives who could then provide safe delivery to women locally going forward, and refer when needed. To increase the chances that we will retain at least some of these women locally we have built in 3 strategies. 1) to train at least 8 women, 2) to choose women who have strong local roots, preferably with a family member who is a traditional birth attendant, and 3) to provide some support for a local business establishment.
We know that you value the hard learned lessons that come with failure. What hard learned lessons have you experienced, what did you learn and how can these be valuable to others?
Anita Zaidi: The biggest lesson is that in many very poor households, even if the pregnant woman has indicated early in pregnancy she wants to deliver in a hospital, when she actually goes into labor, she doesn’t have the wherewithal to act on this desire. She either doesn’t have access to a phone to call for emergency transport, or she can’t make the decision for herself and her husband is not around. We have developed an algorithm that identifies women who are at high risk for being in this situation, and forming local neighborhood groups that can help in time.
What advice would you give other organizations or individuals interested in implementing interventions like yours in similarly impoverished locations?
Anita Zaidi: Building a network of partners is very important. Program should be flexible with learning and modification in response to learning built in as very rapid cycles of learn-modify-act to have quick impact. So failure is an opportunity to learn, motivate, and improve, and therefore regular checkpoints (data gathering points) have to be built into the program to allow this to happen. Measurements at the end, when you can’t change anything are too late. This is a major flaw in most development aid programs.
Anita, you are strong proponent of science-based research and are committed to data. Please indicate why you believe this is important, if not necessary, for global health. More specific to the VITAL project, what is the role and significance of data in the project’s planning and implementation? What has worked? What needs improvement?
Anita Zaidi: I am very data focused because I believe measuring impact and knowing what worked and what didn’t is the only way we can scale efforts, rather than be doomed to repeat mistakes. We need to change the culture of aid to be driving for results, and if something doesn’t work, we shouldn’t consider it a failure, but an opportunity to understand why something didn’t work, and improve the design. Currently much aid, is input and process focused, rather than impact and results focused. This bothers me.
For the VITAL project, data is key to everything we do. We have a set of dashboard indicators that we measure every week (e.g. % of deliveries that week which were in a facility), or every month (neonatal mortality rate, child mortality rate). We even look at our data geo-spatially, by team, by sub-village, to identify patterns, where we are being successful, where we aren’t.
A baseline census of RG was conducted, why was this important and how would it affect your project goals?
Anita Zaidi: We wanted to set a baseline benchmark against which we would be measured. We have a very ambitious goal of 2/3rd mortality reduction in 3 years, so we wanted an external party to document what the baseline was, and the same will be done for the endline survey.
How did you target the participation from the RG community to implement VITAL’s work? What did the numbers for program enrollment look like and what did you think about these?
Anita Zaidi: We work very closely with local community elders and councilors to design and implement this program. There are about 7000 under 5 children in this community and approximately 1100 births per year that we are targeting through this program.
About Dr. Anita Zaidi
In 2013, Dr. Anita Zaidi was awarded the inaugural $1 million Children’s Prize for her proposed plan to save children’s lives in the Rehri Goth fishing village, one of the most impoverished communities in Karachi, Pakistan.
Dr. Zaidi was trained in United States as a pediatrician, microbiologist, pediatric infectious disease specialist, and public health professional. She left a faculty position at Harvard to return to Pakistan where she built a child health research program in impoverished urban and rural Pakistani communities designed to find innovative low-cost solutions to saving children's lives in resource-constrained settings. She is currently the Director of the Enteric and Diarrheal Diseases program at th
e Bill & Melinda Gates Foundation. Prior to the Gates Foundation, Dr. Zaidi was the Ruby and Karim Bahudar Ali Jessani Professor and Chair, Department of Pediatrics and Child Health, at the Aga Khan University in Karachi, Pakistan.
Photo credits: Farheen Khan
Making a real difference: A Q&A with Dr. Anita Zaidi (part 1)
The Children's Prize team interviews the 2013 inaugural competition winner, Dr. Anita Zaidi, about implementing her million dollar life-saving project in Pakistan. It focuses on five key areas including antenatal care, skilled delivery, community care, nutrition and immunization. Read below to see how her results are leading to improved maternal and child health.
Give us a little background on the village where you set up the VITAL Pakistan Trust. Why did you select this area?
Anita Zaidi: I have been working in the impoverished coastal communities of Karachi since 2002. Rehri Goth is a village I got to know well, where lack of access to health services for pregnant women and children, and malnutrition are responsible for large numbers of child deaths. In 2012-2013, one out of every 10 children died before reaching their 5th birthday, over half of them in the first month of life. I thought that if I win the Children’s Prize, we could make a real difference in maternal health and child survival in Rehri Goth.
What are some of the most significant changes you have seen in the community since you started your work?
Anita Zaidi: Some of the earliest changes we have started seeing are in the numbers of women seeking facility-based delivery for their births, which has resulted in a noticeable decrease in newborn death rates of about 20%.
What are some of the challenges you have encountered, and may encounter in the future, as you continue to implement your program?
Anita Zaidi: Changing behavior practiced for centuries is very hard, especially within short time spans, and we have realized that the most marginalized families need specifically tailored approaches. For example, women whose husbands are fishermen and away at sea for many weeks, and yet their wives are not empowered to make decisions regarding facility birth, or hospitalization for their infants if they become sick and need hospitalized care. We are developing and trying behavior change strategies for these situations.
Another challenge is that we under-estimated the very poor health status of pregnant women in Rehri Goth, where about 20% do not just suffer from a high degree malnutrition due to insufficient food, but also have severe anemia which puts their life in danger at the time of birth with no reserve for blood loss. We are finding women with hemoglobin levels as low as 3 mg/100 ml (normal is 12-14 for women).
Health systems strengthening is essential towards improving public health and global health, how will your program aid in the efforts to strengthen the health systems of your community?
Anita Zaidi: We feel that improving access to skilled care at the time of birth is the most important health system change that we need to make for the women and children of Rehri Goth. This is why we have a strong focus on training local women to be midwives, and linking the community with transport and emergency obstetric services.
Changing the legal framework of states, cities, or countries can aid in the progress toward better health for all. In Pakistan, or more specifically in Rehri Goth, what policies are enacted that compliment your work? What are some of the legal barriers that you have faced in implementing your project?
Anita Zaidi: We have not faced any legal or policy barriers in our work. What we have recognized is the serious shortage of emergency obstetric services in the city of Karachi (20 million population) that can cater to women with life-threatening emergencies at night. There are very few hospitals that offer 24/7 emergency services to poor women, and they are overwhelmed. We feel that there is not a private sector solution to this problem, because of disincentives for operative deliveries, and unless we address this issue with a public sector approach we are unlikely to see much improvement in maternal and newborn mortality rates. Pakistan has the worst maternal and newborn mortality rates in the South Asian region.
What are some the most rewarding partnerships forged through your project?
Anita Zaidi: We have been astounded by the generosity and willingness to partner with us by many organizations. I’d specifically mention Koohi Goth Hospital, for offering free delivery services, The Aman Foundation, for providing emergency ambulance services, and the Aga Khan University for offering subsidized services for newborns in need of intensive care support.
About Dr. Anita Zaidi
In 2013, Dr. Anita Zaidi was awarded the inaugural $1 million Children’s Prize for her proposed plan to save children’s lives in the Rehri Goth fishing village, one of the most impoverished communities in Karachi, Pakistan.
Dr. Zaidi was trained in United States as a pediatrician, microbiologist, pediatric infectious disease specialist, and public health professional. She left a faculty position at Harvard to return to Pakistan where she built a child health research program in impoverished urban and rural Pakistani communities designed to find innovative low-cost solutions to saving children's lives in resource-constrained settings. She is currently the Director of the Enteric and Diarrheal Diseases program at the Bill & Melinda Gates Foundation. Prior to the Gates Foundation, Dr. Zaidi was the Ruby and Karim Bahudar Ali Jessani Professor and Chair, Department of Pediatrics and Child Health, at the Aga Khan University in Karachi, Pakistan.
Photo credits: Farheen Khan
Koohi Goth Hospital: On Obstetric Fistula & Restoring Dignity
“Why do women have to leak for thirty long years before finally finding their way to us?” said Dr. Shershah Syed, President of the Pakistan National Forum on Women’s Health (PNFWH).
While on a visit to Pakistan, we had the opportunity to meet a key partner organization working with Dr. Anita Zaidi and her VITAL Pakistan team. This organization, named Koohi Goth Hospital, was established in 2005 and is a project of the Zafar and Atiya Foundation Charitable Trust. This is a family foundation with generations of physicians who are all heart and soul, and deeply committed to vulnerable and underprivileged communities serving poor women and children.
Originally displayed on the Pakistan National Forum on Women’s Health website.
While touring the Koohi Goth facility and learning more about their work, we had the opportunity to spend some time with the amazing and inspiring Dr. Shershah Syed and his team which included Dr. Saboohi Mehdi and Sarwan Kumar. Dr. Syed shared with us the rich family history that has infused his profession. The foundation’s work is unwavering in its commitment to education and health. One of the most striking features shared was the lack of payment for services provided while at Koohi Goth Hospital, a true indication of their mission to provide care for the poor and under-served at no cost.
At its essence, the fundamental belief in the human dignity of each person they service and that education and health are basic human rights became evident as we walked the corridors of the hospital, meeting women of all ages that were being trained as community health workers, midwives, technicians etc. Their and training being provided free of cost and in fact students were rewarded with a living area and a stipend/scholarships during their stay. The emphasis on human dignity was most profound as the discussion shifted to stories of women that experienced obstetric fistula. See story below.
Koohi Goth Hospital offers fistula services and have also incorporated a social integration program to further help the women cope with the depression associated to their experience. In fact, the origins of Koohi Goth Hospital focused on the taboo disease known as the Vesico Vaginal Fistula (VVF), Recto Vaginal Fistula (RVF) among other gyno-related problems. Koohi Goth Hospital continues to actively work towards the elimination of RVF and VVF and the protection women from other labor related complications and gynecologic diseases.
What’s a fistula or an obstetric fistula?
Obstetric fistula is a connection between the vagina and rectum or bladder that is a direct consequence of prolonged or obstructed labor. Women are left incontinent (having no or insufficient voluntary control) of urination or defecation. This condition can be extremely stigmatizing and difficult to live with, leaving these women incapable of leading normal lives.
Why is there an international day to end it?
Because this is a preventable condition that chronically affects some of the most poor and marginalized women in the world, women who live in rural areas where in obstetric care is poor, or non-existent, and skilled labor is difficult to reach. This type of childbirth-related devastation can be fully spared.
How many women are affected?
According to the World Health Organization, between 50,000 to 100,000 women worldwide develop obstetric fistula each year. However, these estimates are based on scanty data and need to be updated. According to the Fistula Foundation, over one million women suffering from obstetric fistula worldwide. Fistula is most prevalent in sub-Saharan Africa and Asia.
The Koohi Goth facility is a 200-bed healthcare center, with about 70-beds currently functional, and providing Obstetric & Gynecological services at no charge and without any discrimination of race, color, caste, or creed. Located in the outskirts of Karachi and conveniently built only 2 kilometers from the National Highway, the hospital serves as a true oasis for maternal health and women’s health in Pakistan. The facility is staffed 24-hours a day by world and country renown specialists like Dr. Shershah Syed, founder of Pakistan National Forum on Women’s Health, who volunteer their time in order to improve maternal health and save the lives of women and children.
We want to honor the work of Dr. Syed, his incredible and noble family, and all the staff at Koohi Goth Hospital for the transformative work they are doing every single day. No woman should have to endure the pain, suffering, and social ostracization that follows an obstetric fistula. Working in collaboration, we can save more lives, and help improve the health of women and children who most need it. Thank you!