Reproductive, Maternal, Newborn and Child Health in India · Reproductive, Maternal, Newborn and Child Health in India ... • New lab testing ... • Point‐of‐care interventions

Reproductive, Maternal, Newborn and Child Health in India

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Report of Workshop on

“Reproductive, Maternal,

Newborn and Child Health

in India”

Date: 13th September 2014

Organized by:

Rapporteur:

Dr. Mugdha Potnis‐Lele,

Scientific Advisor and Program Manager – SIIP

Email: [email protected]

http://www.venturecenter.co.in/campaigns/mch/events.php

mailto:[email protected]

http://www.venturecenter.co.in/campaigns/mch/events.php


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A workshop on “Reproductive, Maternal, Newborn and Child Health in India” was

organized by Bioincubator at Venture Center (Bioincubator at Venture Center is

supported by BIRAC, Government of India) on Saturday, 13th September 2014.

This report contains:

Key Lessons from the workshop 3

Detailed record of the workshop 7

Appendix 1: Workshop outline 15

Appendix 2: Photos 18


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Key Lessons from the workshop

1. Need for diagnostic innovations

• Quick diagnosis of Post‐partum hemorrhage, Eclampsia and Pre‐eclampsia (hypertension with

proteinuria at more than 20 weeks) with fits and obstructed labour leading to uterine rupture,

anaemia, Malaria, Cardiac disease and Hepatitis infections in pregnancy: especially non‐A, non‐B

types

• Detecting fetal / maternal health risks

• Correct estimation of timing of birth and mode of delivery

• Restoring blood volume to bring down hemorrhage related deaths

• Managing critically ill women (Near miss cases) by providing EmOC

• Recognising and managing complications

• Making technology (essential diagnostics, equipment, facilities ) available

• Detecting fetal growth restriction

• Predicting preterm birth

• New lab testing techniques

• New ways of detecting complications

• Upgrading research technologies into usable products.

• Treating children with these diseases with appropriate treatment by improvement in care

seeking and appropriate and timely referrals, case management at the community and health

facility, adequate supply of ORS, zinc, antibiotics, and oxygen, continuation in feeding /

breastfeeding during illness episodes.

• Point‐of‐care interventions for monitoring hemoglobin, preferably non‐invasive method,

measurement of blood loss during delivery minimization of blood loss, eclampsia drills or

obstetric drills, training for giving ampoules in eclampsia cases, simple gadgets for monitoring

fetal movement

• Point‐of‐care diagnostics for Hepatitis B and HIV at the home setting


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• Diagnosis of vaginal discharge during pregnancy

• Development of multivalent (hexa/heptavalent) vaccines to compress the immunization

schedule

• Development of easily available diagnostics for infectious diseases like pneumonia

2. Need for nutritional interventions

• Nutritional interventions: Improving nutrition : Prevention of anaemia, Low Birth Weight babies

• Development of innovative teaching modules to improve nutritional awareness

• Methods to establish linkages and networks with public health systems and NGOs working at

the community level for sustainability of nutrition intervention activities

• Simple gadget to measure length/height of infant (as it has impact on SAM/MAM

categorization)

• Gadget to measure weight of infant/child, especially where floor is not straight

• Nutritionally better and tasty medical nutrition therapy products (eg: nutribars/nutritional chips

or wafers etc)

• Locally produced food products

• Simplification in measurement of height, weight, mid‐upper arm circumference (MUAC) which

give correct categorization of malnutrition status

3. Increasing awareness about health services

• Protecting children by establishing good health practices from birth like exclusive breastfeeding

for 6 months from birth, adequate complementary feeding after 6 months, vitamin A

supplementation.

• Preventing children from infectious diseases by adequate vaccinations, simple hand‐washing

techniques, safe drinking water and sanitation, reducing household air pollution, HIV

prevention.

4. Improving access to health services

• Post‐partum sepsis: due to aseptic precautions and anaemia

• Unsafe abortion: mainly due to teenage pregnancy problems

• Institutionalized deliveries attended by Skilled/trained birth attendants

• Improving access to Institutional health services


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• Availability of affordable and accessible Emergency Obstetric Care (EmOC)

• Availability of Family Planning and safe abortion services

• Reaching out to every pregnant woman: Rural/urban gap; Poverty, ignorance, misconceptions‐

health seeking behavior

• Delivering essential care through pregnancy‐delivery‐postdelivery period

• Deliverying every pregnant woman by SBA in an institution

5. Improving communications by technological innovations

• Communication : Use of SMS, mobile calls

• Mobile apps

• Development of good surveillance systems including AEFI detection and reporting systems

• Surveillance systems

• Mobile apps which act as reminders about immunization schedules

• Electronic devices to maintain immunization records

• Involvement of IT industry to build robust surveillance systems.

6. Need for social change

• Female literacy and Women Empowerment

• Developing educated and aware political will

• Effective information education and communication activities

• Support to indigenous vaccine industry in form of resources (manpower, financial etc)

• Involvement of self‐help groups to provide need based services to women

• Regulations to make immunization compulsory. Eg: at entry at school level immunization record

is mandatory document

7. Establishing legal and regulatory networks

• Regulatory and ethical issues should be addressed

• Integrative approach in designing interventions where medical and non‐medical personnel are

working together in a medical setup.


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8. Need for training to health professionals

• Training to primary health care workers for diagnosis of diseases like cervical cancers

• For improving training to health personnel, development of “near to real life” Mannequins for

use in skill labs

• Education modules for generating awareness and building confidence about vaccines. Wrong

propaganda about vaccines should be discouraged

• Generating awareness regarding rampant use of antibiotics

• Exposure of innovators to primary health care situations to understand the actual needs.


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Detailed record of the workshop

A workshop on “Reproductive, Maternal, Newborn and Child Health in India” was organized by

Bioincubator at Venture Center (Bioincubator at Venture Center is supported by BIRAC, Government of

India) on Saturday, 13th September 2014.

The audience was well represented by participants from the academia, NGOs, technocrats,

entrepreneurs and medical professionals. The workshop began with a brief welcome by Dr. Premnath

introducing the various activities of Venture Center. A brief summary of the earlier workshop conducted

in September 2013 was given by Pradnya Aradhye. Report is shared at:

http://www.venturecenter.co.in/campaigns/mch/

Setting the stage for the workshop was done by Mugdha Lele, where in addition to summarizing the

various problems in the areas of reproductive, maternal, newborn and child health in India, specific lines

of action were suggested as summarized below:

http://www.venturecenter.co.in/campaigns/mch/


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RMNCH problems

Pre‐conception stage• Health informatics• Counseling•Nutritional interventions for better health outcomes • Harmful exposures

Post‐conception stage• Nutritional interventions• Harmful exposures• better access to health care services for better reproductive outcomes• good transport and communication facilities

Neonatal stage• Databases for vital statistics to monitor health outcomes• Early diagnosis for treatment and management strategies• Monitoring facilities for neonates• Management care and health support facilites (transfusion, supportive devices, physiotherapy services)• Pharmaceutical services: Drugs and Therapies

Lines of action

Political will Institutional community and family Frameworks

Some possible industries which could be involved in designing impact giving innovations in this area

were suggested:

• Mechanical / Electronics : Devices

• Biotechnology : Diagnostics

• Health Care

• Pharmaceutical

• Nutraceutical

• ICT

• Automobile and road transport

In her session on “Reproductive problems: Reducing mortalities during child‐birth”, Dr. Aparna Shrotri

highlighted the common medical causes related to maternal deaths which included:

• Post‐partum hemorrhage: where response time is as minimum as 2 hours


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• Eclampsia: Pre‐eclampsia (hypertension with proteinuria at more than 20 weeks) with fits: is a major

cause of death

• Obstructed labour: leading to uterine rupture

• Post‐partum sepsis: due to aseptic precautions and anaemia

• Unsafe abortion: mainly due to teenage pregnancy problems

• Anaemia: cause of 20% deaths in pregnant women, were they die undelivered due to cardiac arrest

• Malaria during pregnancy

• Cardiac disease in pregnancy

• Hepatitis infections in pregnancy: especially non‐A, non‐B types

What are the underlying causes and possible solutions?

Underlying causes of maternal mortality Possible solutions

Reproductive factors: Maternal Age more than 35 & less than 18 years,

parity > 5, unwanted Pregnancy leading to Unsafe Abortion, Inter‐pregnancy

Interval < 2 Years

Availability of family

planning and safe

abortion services

Social factors: Low socio‐economic status of women, lack of education, poor

nutrition, delivery in absence of skilled birth attendant

Facilitating social change

Health Service Related Factors: Deficient Medical Treatment of

Complications, Mistaken or Inadequate Action by Medical Personnel, Lack of

Essential Supplies like Blood, Drugs, Equipment, Lack of Trained Personnel

Improving quality of

services

She highlighted 3 delays where intervention could be targeted:

Delays Targets for interventions

Delay in deciding to seek care Ability to Recognize Life Threatening Complications, woman’s status in

the family, husband’s awareness and presence, distance to &

Knowledge About Health Facility

Delay in reaching treatment

facility

Roads, Transportation, Cost of transport & Care

Delay in receiving adequate

treatment at the facility

Non‐availability of Trained & Dedicated Staff, Drugs & Supplies, Blood


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Some examples which have worked focused on:

• Institutionalized deliveries attended by Skilled/trained birth attendants

• Improving access to Institutional health services

• Availability of affordable and accessible Emergency Obstetric Care (EmOC)

• Availability of Family Planning and safe abortion services

• Female literacy and Women Empowerment

Some suggested interventions were:

• Diagnostic innovations: like anaemia detection & correction.

• Nutritional interventions: Improving nutrition : Prevention of anaemia, Low Birth Weight babies

• Detecting fetal / maternal health risks

• Correct estimation of timing of birth and mode of delivery

• Restoring blood volume to bring down hemorrhage related deaths

• Managing critically ill women (Near miss cases) by providing EmOC

Some challenges:

• Reaching out to every pregnant woman: Rural/urban gap; Poverty, ignorance, misconceptions‐

health seeking behavior

• Delivering essential care through pregnancy‐delivery‐postdelivery period

• Deliverying every pregnant woman by SBA in an institution

• Recognising and managing complications

• Making technology (essential diagnostics, equipment, facilities ) & trained manpower available

Some innovations required were:

• Detection of severe anaemia

• Detecting high blood pressure

• Detecting fetal growth restriction

• Predicting preterm birth

• Communication : Use of SMS, mobile calls


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• Mobile apps

• New lab testing techniques

• New ways of detecting complications

Some life‐saving technologies are available in research settings, but the same are not practically usable.

Hence, innovations should be targeted to upgrade such technologies into usable products.

The talk by Dr. Anuja Jayaraman focused on, “Models for improving nutritional security in community

through technological interventions”. She presented the model of the Aahar program of SNEHA, an

organization working in the Dharavi slums of Mumbai to improve the nutritional status of children under

3 years of age, to bring down wasting (severe acute malnutrition‐SAM and moderate acute malnutrition‐

MAM). This project is using technology in the form smart phones to collect information, to calculate

malnutrition based on these data and plan interventions accordingly. Using technology has resulted in

easy scalability and replicability of this model, data visualization is instant/real time and easy, immediate

feedback can be given to the field workers by the supervisors. Intervention is in the form of Medical

Nutrition Therapy (MNT), which is a formulation prepared for the SAM and MAM children to restore

them to normalcy.

In her talk on nutritional interventions in adolescent girls, Angeline Jeyakumar highlighted that an

integrated approach need to be taken at the community level. Interventions need to be targeted at the

individual level (adolescent girls), organizational level (NGOs) and schools. Some teaching modules using

the play‐way method were developed for these interventions. Also there is a need to establish linkages

and networks with public health systems and the NGOs working at the community level for

sustainability of these nutrition intervention activities.

On the problems related to Vaccines and Immunization, Dr. Prasad Kulkarni highlighted the problems

related to immunization coverage in the Indian scenario which include:

• Huge population growth rates

• Poor access

• Huge inter‐state variations in coverage

• Large geographical diversity

• Political instability

• Cultural diversity and barriers


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• Migrant population

• Lack of awareness and motivation on part of recipients and health care providers

• Adverse events following immunization (AEFI): eg: Pentavalent vaccine related deaths

• Weak surveillance system to track burden of vaccine preventable diseases

• Inadequate health services (poorly trained and inadequate staff, poor supply for vaccines etc)

• Falsification of data and over‐reporting of rates

• Emergency applications of vaccination over‐emphasized rather than preventable. Eg: H1N1

vaccine

Key challenges in this field are:

• Price point pressure

• Temperature sensitive supply chain

• No regulatory guidelines developed in India

• Lag period for availability of vaccines in developed and developing countries

• Lack of access to technologies in India

Some solutions:

• Developing educated and aware political will

• Effective information education and communication activities

• Development of good surveillance systems including AEFI detection and reporting systems

• Regulatory and ethical issues should be addressed

• Support to indigenous vaccine industry in form of resources (manpower, financial etc)

Dr. Agharkhedkar highlighted the rampant use of antibiotics in the treatment of infectious diseases like

pneumonia as a major problem. Also more research needs to be done on the different pathogens

causing pneumonia and the ways they are transmitted. Advocacy should also be done for the strategy of

“protect, prevent and treat” for reducing the morbidity and mortality due to pneumonia and diarrhea.

This includes:


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• Protecting children by establishing good health practices from birth like exclusive breastfeeding

for 6 months from birth, adequate complementary feeding after 6 months, vitamin A

supplementation.

• Preventing children infectious diseases by adequate vaccinations, simple hand‐washing

techniques, safe drinking water and sanitation, reducing household air pollution, HIV

prevention.

• Treating children with these diseases with appropriate treatment by improvement in care

seeking and appropriate and timely referrals, case management at the community and health

facility, adequate supply of ORS, zinc, antibiotics, and oxygen, continuation in feeding /

breastfeeding during illness episodes.

Panel discussion was carried with the participation of all speakers and moderated by Dr. Premnath. The

discussion on priorities of intervention had the following suggestions:

Maternal interventions:

• Point‐of‐care interventions for monitoring hemoglobin, preferably non‐invasive method

• measurement of blood loss during delivery

• minimization of blood loss

• eclampsia drills or obstetric drills

• training for giving ampoules in eclampsia cases

• simple gadgets for monitoring fetal movement

• Point‐of‐care diagnostics for Hepatitis B and HIV at the home setting

• Diagnosis of vaginal discharge during pregnancy

• Training to primary health care workers for diagnosis of diseases like cervical cancers

• Involvement of self‐help groups to provide need based services to wormen

• For improving training to health personnel, development of “near to real life” Mannequins for

use in skill labs.

Nutritional interventions:

• Simple gadget to measure length/height of infant (as it has impact on SAM/MAM

categorization)

• Gadget to measure weight of infant/child, especially where floor is not straight


Page 14 of 18

• Nutritionally better and tasty medical nutrition therapy products (eg: nutribars/nutritional chips

or wafers etc)

• Locally produced food products

• Simplification in measurement of height, weight, mid‐upper arm circumference (MUAC) which

give correct categorization of malnutrition status

Vaccination/immunization related interventions:

• Surveillance systems

• Education modules for generating awareness and building confidence about vaccines. Wrong

propaganda about vaccines should be discouraged

• Mobile apps which act as reminders about immunization schedules

• Development of multivalent (hexa/heptavalent) vaccines to compress the immunization

schedule

• Regulations to make immunization compulsory. Eg: at entry at school level immunization record

is mandatory document

• Electronic devices to maintain immunization records

Interventions in the field of respiratory illnesses:

• Generating awareness regarding rampant use of antibiotics

• Development of easily available diagnostics for infectious diseases like pneumonia

Other suggestions:

• Integrative approach in designing interventions where medical and non‐medical personnel are

working together in a medical setup.

• Exposure of innovators to primary health care situations to understand the actual needs.

• Involvement of IT industry to build robust surveillance systems.

The event concluded by a Skype call with Sonia Gandhi the Program Manager for the SPARSH scheme

from BIRAC‐DBT. A call for proposals has been given for “Reproductive, Maternal, Newborn and Child

Health”. Also details regarding the Social Innovations Immersion Program under the SPARSH scheme

were shared. Further details are available on the BIRAC website.


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Appendix 1

Workshop Outline

Time Session title Faculty

0930‐945 Registration

0945‐1000 Welcome to Venture Center BioIncubator. Introduction to the

workshop.

Pradnya Aradhye

1000‐1015 Quick update of MCH 2013 event: Action taken and results Pradnya Aradhye

1015‐1030 Overview of disease burden for:

• Reproductive and maternal problems

• Newborn and Child health problems

Setting the stage with an overview of key issues

Pradnya Aradhye

Mugdha Lele

1030‐1100 Reproductive problems: Reducing mortalities during child‐birth Aparna Shrotri

1100‐1115 Networking tea

1115‐1145 Models for improving nutritional security in community through

technological interventions

Anuja Jayaraman

1145‐1215 Nutritional interventions for adolescent girls: impact on reproductive,

maternal, newborn and child health

Angeline Jeyakumar

1215‐1300 Vaccines and immunization: Problems in the Indian scenario Prasad Kulkarni

1300‐1400 Lunch Break

1400‐1500 Panel discussion

• Identification and stream lining of certain key issues related to

Reproductive, Maternal, New born and Child health: Defining

problems and areas where technology interventions are needed,

exploring user‐friendly solutions for using in the community set

Moderator: Premnath V

Panelists: Sharad

Agarkhedkar, Aparna


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up. Where will technology intervention work within a reasonable

time frame and cost? Ideas for compilation and for the workshop

white paper.

Shrotri, Anjeline Jeykumar,

Anuja Jayaraman, Prasad

Kulkarni

Rapporteur: Mugdha Lele

1500‐1530 Diagnostic limitations for the common respiratory illnesses Sharad Agarkhedkar

1530‐1600 An overview of emerging funding opportunities: SPARSH from BIRAC

focused on Reproductive, Maternal, Newborn and Child Health

(Deadline: 30 Sept 2014)

Pradnya Aradhye

1600‐1630 Q&A for SPARSH funding scheme: (over SKYPE) BIRAC: Sonia Gandhi

1630‐1645 Insights by 2013 SPARSH grantees

1645‐1700 Closing comments and closure of the event and Tea

Speakers and Panelists (in alphabetical order of last names)

SHARAD AGARKHEDKAR

Sharad Agarkhedkar is MD in Pediatrics and currently Professor and Head of Department of Pediatrics at Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre. He has few national and international publications to his credit and is involved in mentoring post-graduate students in research and academic activities.

PRADNYA ARADHYE

Pradnya Aradhye is currently Associate, Bioincubator, Venture Center. She has done her M.Tech in Biological Sciences and Bioengineering from IIT Kanpur. Currently she is handling all BioIncubator activites at Venture Center. She is responsible for creating a pipeline of potential and signing-up incubates for the Bioincubator. Contribute to building scientific support systems and resources for VC incubates including specific expertise. Discussions with scientists to understand their competencies.

SONIA GANDHI

Sonia Gandhi is currently assisting the Investment group of BIRAC, New Delhi as Project Manager and is responsible for proper functioning of the grants management system, ensuring compliance to regulations, evaluation and management of projects as per guidelines. Previous to this she worked with BIRAP as Program Manager for Healthcare with responsibility of Techno-commercial guidance and support for projects in identified areas of Healthcare Industry. Prior to this, she was in Quality Management Systems of Reliance Life Sciences and is involved in ensuring the compliance of various processes of the product development to applicable regulatory guidelines. She is double Masters in Biotechnology and Quality Management and also a Certified Quality Management Professional from Birla Institute of Technology and Science and Reliance Institute of Life Sciences. She also visited the EMA, MHRA, HTA and NICE offices at UK to understand the regulatory scenario impacting Medical Devices, Clinical Trials, Vaccines and Stem Cells development.


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ANJELINE JEYAKUMAR

Anjeline Jeyakumar has done her M.Sc. In Nutrition and Dietetics and M.Phil in Foods and Nutrition. Her doctoral work focuses on Iron deficiency among adolescent girls. She has been the coordinator of the Masters' programme in dietetics at the School of Health Sciences, University of Pune. She is also coordinating the UGC funded e-pathshala project for Public health nutrition. She is a visiting faculty at SNDT Women’s University.

ANUJA JAYARAMAN

Dr Anuja completed a PhD in Agricultural, Environmental and Regional Economics and Demography from the Pennsylvania State University, USA and has over 10 years of rich and varied international experience in the field of development. She has expertise in monitoring and evaluation of health programs. Her research focuses on areas of non - income dimensions of well - being including health (maternal and child health, HIV / AIDS), housing and education in the context of South Asia and Africa.

PRASAD KULKARNI

Prasad Kulkarni is MD in Clinical Pharmacology and is currently Medical Director at Serum Institute of India Ltd., Pune. He has been involved in many clinical trials on vaccines like BCG, Measles, Rubella, Hepatitis B, Hib, H1N1, Influenza to name a few and various therapeutic products. He has several national and International publications to his credit. He has also been an advisor to WHO. He is a visiting faculty at various research and academic institutes in the country and has been a part of Institutional Ethics Committees. He is also associated with some journals in the capacity of editorial board member and referee.

MUGDHA LELE

Dr Mugdha Lele is a Scientific Advisor at Venture Center, NCL Innovation Park, Pune. She was previously an Assistant Professor in Dept of Genetics, Immunology and Biochemistry at Maharashtra University of Health Sciences. Her research work is related to epidemiological profiling and development of molecular diagnostics for Genetic disorders. She has a few national and international publications to her credit.

APARNA SHROTRI

Aparna Shrotri has been a Professor at Dept of Obstetrics & Gynecology, B. J. Medical College, Pune. She is currently visiting faculty at Maharashtra University of Health Sciences. She is Member and Chairperson of Institutional Ethics committees of various medical and research institutions. She has several national and international publications to her credit. She is also master trainer for training programs in reproductive health for Govt of Maharashtra.

PREMNATH VENUGOPALAN

Dr. V. Premnath Founding Director – Venture Center and Head, NCL Innovations.He holds a B.Tech. from the Indian Institute of Technology - Bombay and a Ph.D. from the Massachusetts Institute of Technology, USA. He has also been a Chevening Technology Enterprise Fellow with the Centre for Scientific Enterprises, London Business School and Cambridge University, UK. He brings with him considerable experience in technology development and commercialization, working with start-up companies (in Cambridge-UK and India) and engaging with large corporations on research and consulting projects as project leader.


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Appendix 2:

Photos

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Reproductive, Maternal, Newborn and Child Health in India · Reproductive, Maternal, Newborn and Child Health in India ... • New lab testing ... • Point‐of‐care interventions