Devices and furniture for small and sick newborn care: systematic development of a planning and costing tool.

Background: High-quality neonatal care requires sufficient functional medical devices, furniture, fixtures, and use by trained healthcare workers, however there is lack of publicly available tools for quantification and costing. This paper describes development and use of a planning and costing tool regarding furniture, fixtures and devices to support scale-up of WHO level-2 neonatal care, for national and global newborn survival targets.

Methods: We followed a systematic process.

Target product profiles for neonatal care devices: systematic development and outcomes with NEST360 and UNICEF.

Background: Medical devices are critical to providing high-quality, hospital-based newborn care, yet many of these devices are unavailable in low- and middle-income countries (LMIC) and are not designed to be suitable for these settings. Target Product Profiles (TPPs) are often utilised at an early stage in the medical device development process to enable user-defined performance characteristics for a given setting. TPPs can also be applied to assess the profile and match of existing devices for a given context.

Avoid equipment graveyards: rigorous process to improve identification and procurement of effective, affordable, and usable newborn devices in low-resource hospital settings.

Background: Millions of newborns die annually from preventable causes, with the highest rates occurring in Africa. Reducing neonatal mortality requires investment to scale hospital care, which includes providing hospitals with appropriate technology to care for small and sick newborns. Expensive medical devices designed for high-resource settings often fail to withstand conditions in low-resource hospitals, including humidity, dust, frequent user turnover, complex maintenance, lack of stable power, or difficulty sourcing expensive consumables.

In vitro comparison of performance including imposed work of breathing of CPAP systems used in low-resource settings.

Respiratory distress due to preterm birth is a significant cause of death in low-resource settings. The introduction of continuous positive airway pressure (CPAP) systems to treat respiratory distress significantly reduced mortality in high-resource settings, but CPAP was only recently introduced in low-resource settings due to cost and infrastructure limitations. We evaluated pressure stability and imposed work of breathing (iWOB) of five CPAP systems used in low resource settings: the Fisher and Paykel bubble CPAP, the Diamedica baby CPAP, the Medijet nCPAP generator, and the first (2015) and second (2017) generation commercially available Pumani CPAPs.

Evaluation of a continuous neonatal temperature monitor for low-resource settings: a device feasibility pilot study.

Objective: Evaluate a novel continuous temperature monitor in a low-resource neonatal ward.

Design: We developed a low-cost continuous neonatal temperature monitor (NTM) for use in low-resource settings. Accuracy of NTM was initially assessed in the laboratory.

Evaluation of a low-cost, low-power syringe pump to deliver magnesium sulfate intravenously to pre-eclamptic women in a Malawian referral hospital.

Background: Magnesium sulfate is an affordable and effective treatment for pre-eclampsia and eclampsia. In settings where infusion pumps are not available to regulate the flow rate of intravenous delivery, healthcare providers must administer magnesium sulfate (MgSO) via time-consuming and painful, large-volume intramuscular injections. As an alternative to costly commercially available syringe pumps, we developed AutoSyp, an accurate, low-cost, and low-powered syringe pump designed to meet the needs and constraints these low-resource settings.

AutoSyP: A Low-Cost, Low-Power Syringe Pump for Use in Low-Resource Settings.

This article describes the design and evaluation of AutoSyP, a low-cost, low-power syringe pump intended to deliver intravenous (IV) infusions in low-resource hospitals. A constant-force spring within the device provides mechanical energy to depress the syringe plunger. As a result, the device can run on rechargeable battery power for 66 hours, a critical feature for low-resource settings where the power grid may be unreliable.

A Shipping Container-Based Sterile Processing Unit for Low Resources Settings.

Deficiencies in the sterile processing of medical instruments contribute to poor outcomes for patients, such as surgical site infections, longer hospital stays, and deaths. In low resources settings, such as some rural and semi-rural areas and secondary and tertiary cities of developing countries, deficiencies in sterile processing are accentuated due to the lack of access to sterilization equipment, improperly maintained and malfunctioning equipment, lack of power to operate equipment, poor protocols, and inadequate quality control over inventory. Inspired by our sterile processing fieldwork at a district hospital in Sierra Leone in 2013, we built an autonomous, shipping-container-based sterile processing unit to address these deficiencies.

Outcomes of Patients with Respiratory Distress Treated with Bubble CPAP on a Pediatric Ward in Malawi.

Objective: To describe the outcomes of infants and young children with respiratory distress when treated with a novel, low-cost, stand-alone bubble Continuous Positive Airway Pressure (bCPAP) system in a resource-limited setting.

Methods: A non-randomized, convenience sample study in a pediatric unit in Blantyre, Malawi, 2013. Patients weighing ≤10 kg with respiratory distress were eligible.

Maji: a new tool to prevent overhydration of children receiving intravenous fluid therapy in low-resource settings.

We designed and evaluated the accuracy and usability of a device to regulate the volume of fluid dispensed during intravenous drip therapy. The mechanical system was developed in response to a pressing need articulated by clinicians in pediatric wards throughout sub-Saharan Africa, who require a tool to prevent overhydration in children receiving intravenous fluid in settings that lack burettes or electronic infusion pumps. The device is compatible with most intravenous bags and limits the volume dispensed to a preset amount that can be adjusted in 50 mL increments.

Abdominal fat suspension device for maintaining normal cardiorespiratory function in patients undergoing conscious sedation during surgery: a feasibility study.

Obese patients undergoing conscious-sedation surgery have increased perioperative morbidity because their excess abdominal tissue limits diaphragmatic excursion. We describe a simple device that might help attenuate this risk. We created a noninvasive suction device for abdominal suspension.

Novel open-source electronic medical records system for palliative care in low-resource settings.

Background: The need for palliative care in sub-Saharan Africa is staggering: this region shoulders over 67% of the global burden of HIV/AIDS and cancer. However, provisions for these essential services remain limited and poorly integrated with national health systems in most nations. Moreover, the evidence base for palliative care in the region remains scarce.

A hand-powered, portable, low-cost centrifuge for diagnosing anemia in low-resource settings.

This report describes the development of a hand-powered centrifuge to determine hematocrit values in low-resource settings. A hand-powered centrifuge was constructed by using a salad spinner. Hematocrit values were measured by using the hand-powered device, and results were compared with those of a benchtop centrifuge.

Portable, battery-operated, low-cost, bright field and fluorescence microscope.

This study describes the design and evaluation of a portable bright-field and fluorescence microscope that can be manufactured for $240 USD. The microscope uses a battery-operated LED-based flashlight as the light source and achieves a resolution of 0.8 microm at 1000x magnification in fluorescence mode.

Mechanical testing of small fracture implants for comparison of insertion and failure torques.

Introduction: Small fracture screws are among the most commonly used implants in the field of orthopedic surgery. The goal of this study was to compare the insertion and failure torques of three screw types: cortical, partially threaded cancellous, and fully threaded cancellous from three manufacturers: Zimmer, Richards, and Synthes.

Materials And Methods: Each type of screw was subjected to biomechanical tests to determine the insertion ( n=6/group) and failure ( n=10/group) torques.

Effect of local density changes on the failure load of the proximal femur.

Hip fracture among the elderly is a large and growing public health issue. Presently, all therapies approved for treatment and prevention of osteoporosis involve pharmacological agents that act systemically. In this study, we evaluated the feasibility of preventing osteoporotic hip fractures with local, rather than systemic, therapy.

The effect of trabecular structure on DXA-based predictions of bovine bone failure.

The objective of this study was to determine the influence of structural organization on the relationship between clinically assessed bone mineral density (BMD) and strength of trabecular bone. Accurate assessment of bone strength or fracture risk is a critical need as the population ages and the incidence of fractures increases. While ex vivo tests have demonstrated that BMD measured with dual-energy X-ray absorptiometry (DXA) correlates with failure load of whole bones, it is also known that the strength of trabecular bone cannot be explained by density alone.