According to Dr. Kim Dickson (2017), a United Nations Population Foundation representative, Sierra Leone has one of the world's highest estimated maternal mortality ratios of 1,165 deaths per 100,000 live births. These deaths have a drastic impact on the Sierra Leonean people and their economy. Studies have found that they have an increased mortality risk and decreased nutrition and schooling. It can also decrease a society's productivity given that the deceased mother is no longer able to contribute to her community's needs (National Research Council, 2000).

Causes of Maternal Death (1997-2002) in Africa, Source: Progress for Children 7 (UNICEF, September 2008)

The leading cause of maternal mortality is postpartum bleeding. Postpartum bleeding is usually a result of poor uterus contractions following childbirth. It is particularly dangerous to women in rural areas as they can bleed to death before reaching the hospital. Most women die while waiting for treatment (Maine et. al., 1991).

Therefore, new mothers in Sierra Leone need access to a low-technology, first-aid device designed to slow down postpartum hemorrhaging until they can be treated because medical attention may not close by and their death would have a dire effect on their child and community.

Dickson, K. (2017). Sierra Leone's latest maternal death and surveillance report (MDSR), released today in Freetown. Retrieved from http://sierraleone.unfpa.org/en/news/sierra-leone%E2%80%99s-latest-maternal-death-and-surveillance-report-mdsr-released-today-launch.

Maine D., Rosenfield A., McCarthy J., Kamara A., & Lucas A (1991). Safe motherhood programs: options and issues. New York, NY: Columbia University.

National Research Council (2000). The Consequences of Maternal Morbidity and Maternal Mortality: Report of a Workshop. Washington, DC: The National Academies Press.

How an NASG can support a woman suffering from obstetric hemorrhaging.

The non-pneumatic anti-shock device is mainly used in low resource countries like Sierra Leone for women suffering from uncontrollable postpartum hemorrhage. It has the tendency to reverse hypovolaemia shock, and could stabilize the patient upon referral to a comprehensive obstetric care facility and thus a life-saving device. One method of managing postpartum hemorrhage is the use of a non-pneumatic anti-shock garment (NASG). Postpartum hemorrhage is a leading cause of maternal death so the effective use of this device in low resource countries will greatly help in reversing the high mortality rate. It can be useful in the Sierra Leone community as women die mostly as a result of the delay in deciding to seek care, delay in transportation to get to the facility and when at the facility delay in obtaining quality care so the use of the device is more feasible and marketable. The NASG is a lightweight neoprene garment that is made up of five segments which close tightly with Velcro. The device applies pressure to the lower body and Abdomen, thereby stabilizing vital signs and resolving hypovolemic shock. When fitted correctly it forces blood to the essential organs like the heart, lungs and brain. What makes it more feasible and marketable, is that it can be reused. It can be applied safely on the woman without causing any irritation on her skin. It is can be cost effective and can be easily handled.

http://www.who.int/medical_devices/innovation/new_emerging_tech_30.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834872/

http://www.safemotherhood.ucsf.edu/nasg/

In order to prototype this device, we would set up two groups in Sierra Leone. One would stay in a make-shift lab space, while the other is out in the community. The group out in the community would go to birthing clinics and ask what is usually done to help women survive while being transported, how far the closest hospital is, and how quickly the technology needs to be applied to the hemorrhaging woman. This information will help us tweak our design to the specific area.

To make the design out of materials in the area, we try a combination of compression socks for the legs, and then try wrapping fabric tightly around a women’s abdomen to see if this works. Developing something that elevates the women’s lower body, such as a sling she can put her feet in could help too, but it depends on if she is being transported in a truck or a motorbike. Materials and elements can be tweaked right away in the lab as the group in the field learns more. This way, we would know the prototype we have is something wanted out in the real world, since doctors helped impact the design. The material should ideally conform to the standsards listed by the device as defined in the WHO manual. It should use compressive material along with a velcro sustem, and the material should fit the correct size of the patient as to not cause injury. Additionally, it is composed of 5 compoents - two strips for each leg, and one for the abdomen.

Next, we would take the final design and go back to the hospitals and clinics to measure interest (ILI). We would do this through in-person surveys, since online questionnaires are not the best way in Sierra Leone since access to internet might be limited. We would ask nurses and midwives how many of them would want the device if they could have the choice between the device or 2-3 others, and measure how many picked our device over the others. This way of testing was chosen because in resource-limited settings, simply asking “would you take it if it was given to you” would often yield the answer yes. Posing the question as a choice between other devices proves to us that they would be willing to put their limited resources towards our device. OLI would be slightly harder to measure since it is not through an online poll, but we would contact the hospitals and clinics continuously while we begin producing our design to see if the interest is still there. If 50% of hospitals and clinics choose our device over 2-3 others, then we would consider that as a success and move on in the process of making the device a reality.

Build Feasibility:

The main component necessary for this product is the material. Each part of the NASG should theoretically be easy to replace, but import regulations from China may become an issue if a customer requests less than the minimum 1000 units. The company Pathfinder International has provided a curriculum and training materials, depending on the target audience, and this should be easy to follow in any environment. There are no additional materials required for operating the device, which is why is can be used both at home and in medical settings. Any environment is suitable for the products use. Basic post-pregnancy treatment should account for problems after the use of this device. The NASG itself is only urgent in emergency cases to return vital signs to normal. Once the mother is stabilized, aftercare can follow as normal without the device.

Market Feasibility:

This product is listed at the low cost of $53.76 USD. It can be used approximately 40 times in one lifespan. At about $1.34 per use for the potential result of saving someones life, this product should definitely fit within a low budget. However, the product is NOT one-size-fits-all, and problems arise if women are too large to fit into the product. Extra budget considerations need to be put in place for ordering the correct number in the correct sizes. Maintainance is mostly the post-cleaning performed by hospital orderlies using water and bleach. The design does state that it is difficult to track the proper cleaning of the device. Course curriculum and training materials are provided depending on the intended audience. This can vary from family members to midwifes and technicians. The main concern is applying or removing the garment. With adequate training and provided materials, there should be sufficient amounts of trained professionals in any given hospital or clinic to properly operate and clean the NASG.

http://www.who.int/medical_devices/innovation/new_emerging_tech_30.pdf

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