On September 4, 2018, like we have always done, the RAN multidisciplinary team convened to support young and enthusiastic innovators to realize their potentially transformative innovative ideas and approaches. It is during these sessions when we listen to and also give feedback to the innovators to further inform the iteration and development of the proposed innovative solutions. It is through such sessions that RAN can also identify additional innovative solutions to support with SEED funding, innovators are also listed as RAN other supported (without financial support) innovations, innovators are linked to other potential partners and funders across the RAN network etc. During these sessions, Innovators are encouraged to present their proposed solutions sharing; Introduction and the Problem, the available solutions, proposed solution and its uniqueness.
Pitch 1: Maternal Health Application
Introduction and Problem
According to UBOS 2016, maternal mortality rate in Uganda is at 336 deaths per 100,000 live births with most studies showing that health facility accessibility is the biggest problem leading to maternal and child health during pregnancy. However, in addition to delays in accessibility to the health facility, provision of inappropriate medical care while at the health facility which is stipulated in the “three delays model” by Maine et al., (1994) is marked as one of the causes of delivery complications while at the health facility.
According to WHO ANC guidelines of 2016, health systems interventions to improve utilization and quality of ANC recommend a minimum of eight contacts to reduce perinatal mortality and improve women’s experience of care. During all these contacts, pregnant women are expected to be diagnosed depending on the well-being and as well the information they provide to the medical worker. However, proper diagnosis and health care delivery depends on appropriate health information that is provided by the pregnant woman. Given the fact that these visits take place in intervals of not less than two weeks, a pregnant woman may not recall all the health events ranging from nutritional records, gynaecological events and other related records required by the medical worker upon that visit. This is as well enhanced by the vulnerable nature of pregnant women who may find the frequent contacts emotionally disturbing as a result of the different information of two or more weeks ago required by the health worker.
Therefore, this application is meant to improve adherence of the new recommended eight weeks of contact with a health worker through solving issues of recall bias, too much information being asked upon a visit and also enable women track their own health on a daily basis throughout the period of pregnance. It as well improves diagnosis, prescription of appropriate medication and also proper nutritional recommendations
Most applications that are currently available are dealing with mitigating the problem of accessibility to health facilities by pregnant women and this has greatly contributed to the reduction of maternal mortality rate from 438 deaths per 100,000 live births as registered in 2011 to 336 deaths per 100,000 live births in 2017. Some of these applications include the gifted mom application which provides mobile services about maternal health information, Safe pregnancy and birth application which is an award-winning app providing information about safe delivery, what to do when a danger sign presents during pregnancy etc.
The proposed solution and its uniqueness
With most applications aiming at bridging the gap of health facility accessibility, this application is aimed at daily capture of Health information of pregnant women throughout the three trimesters up to the time of delivery for easy and early detection of any associated health risks and further follow up with provision of appropriate antenatal care services to facilitate good maternal health during pregnancy and hence further more mitigating the high rates of maternal mortality in Uganda. The application will entail all required questions of suspected health risks that might occur during pregnancy, it shall be incorporated in an alarm system that will be able to work with the mobile phones alarm setting timed at appropriate time intervals by the user to alert them to enter their daily experiences mostly any faced health complications in that applications questioner and form.
Feedback shared with the Innovator
- Slide quality should be improved. It is important to use more visuals and less text.
- The presentation should be generally improved to a standard pitch – a slide should have maximum of 5 statements with 7 words maximum.
- The app shall require a learning model? How are these events standardized?
- Use a demo on how the app works instead of text…refer to presentations by Tim cook among related others.
- Why is it the woman retrieving the information? So can’t the woman record these in a book instead?
- The partners who will be included in the business model canvas should have corresponding contributions.
- Check the uniqueness in the “value proposition”
- Need to improve the writing so that the problem comes out clearly.
- Clearly indicate how data safety is catered for in the proposed application or innovative solution.
- The Innovator needs to get into the mind of the user and think about the incentive that the user will be happy to purchase and actually use the application. What does the mother stand to gain from this application? What is the catch in this application? These are key questions to further guide adoption/usage.
- There is need to be clear on the variables the mothers are going to input. For example what information is keyed in once and keyed in regularly?
- The Innovator also needs to know the key signals/indicators in pregnancy.
- It is important for innovators to conduct user needfinding. Engage the pregnant women so that you gather insights for further development of this application.
- Please read about “Ecolocial momentary assessment.” https://www.researchgate.net/profile/Michael_Hufford/publication/5340880_Ecolocial_Momentary_Assessment/links/0fcfd50ba0b1740ac2000000.pdf
- Ensure that the app does not give false confidence that the mother is well and does not need to visit for ANC.
Pitch 2: Combined Test Cassette
Malaria, brucellosis and typhoid are some of the most prevalent disease in Africa with malaria taking the biggest share followed by brucellosis and lastly typhoid. These diseases are usually diagnosed basing on common symptoms such as chills, fever and muscle weakness. This has led to misdiagnosis of malaria for typhoid and brucellosis in most resource limited areas which results to wrong prescription of antimalarial drugs for typhoid and brucellosis.
An idea of a combined test cassette that detects malaria, typhoid and brucellosis simultaneously has been developed by this innovator team. This will solve the problem of misdiagnosis hence correct prescription. It will equally save both the patients’ and health workers’ time. It will also reduce on the patients’ expenditure.
The test cassette will have different antibodies specific for the respective antigens. The dye labeled antibodies will be embedded in nitrocellulose paper. The cassette will have three test lines each with specific antibodies for a single type of antigen. It shall have a single control line with anti-dye labeled antibodies.
Mode of Action
For a positive test, antigens in the human sample bind with the dye labeled antibodies embedded in the cassette. The complexes formed will move by immune chromatography and are captured by their complementary antibodies along the test lines. The excess dye labeled antibodies will be trapped by anti-dye labeled antibodies along the control line. This principle is for immune chromatography.
For a negative test, the dye labeled antibodies move and are all captured by the anti-dye labeled antibodies along the control line. No test line shows a result.
- For a positive test for any of the diseases, a red line is observed at the test line and at the control line.
- For a negative test for any of the diseases, a red line is only observed at the control line.
Quality Control Measures
- The cassette will be labeled with its respective diseases at the various test lines.
- For every new batch, three cassettes will be obtained and used to test for each of the diseases independently using positive controls. A fourth cassette will be used for negative controls.
Feedback to the Innovator
- It is important to look into how you are formulating the control line so that it combines the three parameters.
- The problem did not come out clearly? Is it about the cost or the lag in diagnosing?
- You need more evidence that the problem you are solving is the cost. This is because the source of the cost embedded in the RDTs is the antigens and in this test the 3 antigens are still in the test cassette. The cost should come out clearly also as the cost of materials for making different strips.
- In your pitch the key thing that should come out and create a better justification for your cassette is misdiagnosis. Many times once malaria is missed many people leave it at that. This cassette therefore solves the costs of false treatment. By combining the 3 u reduce the time and costs.
- Choice of diseases: Your test is more likely to be segregative because these diseases’ prevalence is different geographically. So you need to recommend the geographical
- Dynamics: What are the haemo-chromatographic properties of Malaria, Typhoid and Brucellosis? Do the antigens move at the same speed through the matrix? Ensure that the antigens for the three diseases do not cross react.
- For the next pitch you need to present your RDT choice for malaria, typhoid and Brucellosis.
- You are advised to read about the predictive value of a test for a disease as you develop the cassette.
- As you develop this, note the limitations for this cassette.
- For you to combine the 3 diseases you need to convince that categorically epidemic and endemic diseases can manifest in some areas in the country.
At the end of the Pitch Tuesday session, the Innovators go back to work on the feedback above in an effort to further develop their solutions.