Obstetric haemorrhage, pre-eclampsia and sepsis account for more than 50% of maternal deaths worldwide. Early detection and effective management of these conditions relies on vital signs monitoring, including pulse and blood pressure. The team behind this Newton-Bhabha project has developed a novel device called the CRADLE Vital Sign Alert that can detect abnormal vital signs and the risk of deterioration due to common pregnancy complications. It can be used and understood by anyone thanks to its inbuilt traffic light alert.
By Katy Kuhrt
Our project was born out of a strong collaboration with Indian researchers via the Newton-Bhabha fund. Through that project, more than 3,300 devices have been delivered to hospitals and clinics in developing countries and more than 1,500 healthcare workers have been trained to use the device. Implementation continues in Sierra Leone, Ethiopa, Haiti and India.
In November 2017 we were awarded the Newton Prize, which will enable us to introduce 880 CRADLE Vital Sign Alert devices to all health centres and volunteer health team workers in Bidibidi and Nakivale refugee settlements in Uganda.
There are 1.4 million refugees in Uganda, Africa’s largest refugee crises. Fifty-two percent of the population are female. Over half of maternal death is caused by pregnancy-related bleeding, infection and high blood pressure. Detection of these conditions requires monitoring of vital signs (blood pressure, pulse rate and shock) to enable referral and delivery of simple, potentially life-saving medical treatment. However, health systems in Uganda’s refugee settlements are badly equipped to monitor vital signs, delaying delivery of care to mothers, and to other non-pregnant patients suffering from common, easily treatable conditions. During our initial scoping visit to Bidibidi refugee settlement we found only three working blood pressure monitors across three health centres to serve a population of 56,000 people.
This is the first time the CRADLE VSA will be introduced in a refugee settlement and evaluated for its ability to improve disease detection in non-pregnant as well as pregnant adults. We think that the CRADLE VSA is going to be particularly well suited to this setting, because it has been specifically developed for use in low resource environments, in that it is cheap (less than £20), portable, robust and easy-to-use, even by non-medically trained volunteer health team workers in the refugee settlement who have only 2 weeks’ training. It has a unique inbuilt traffic light system, where a red, yellow or green light is triggered to show on the device, depending on the blood pressure and heart rate reading, which helps to guide subsequent management. It is the most extensively validated blood pressure device for pregnant women and has also been shown to be very accurate in non-pregnant adults too.
In Bidibidi and Nakivale Refugee Settlements we will evaluate the CRADLE as a tool to aid detection of common diseases, including Malaria, chest and urine infections and gastrointestinal problems, as well as life threatening pregnancy complications, so that patients can be referred for timely medical attention.
The Newton Prize has facilitated this project, which could lead to roll out throughout Uganda and across the world - truly global impact, at a time when there are 20 million refugees worldwide; more than at any time since the end of WWII.
In addition, the Newton Fund has enabled a collaboration between our team at Kings College London’s Women’s Health Academic Centre at St Thomas’ Hospital in London and the Women’s and Children’s Health Research Unit at Jawaharlal Medical College in Belgaum in India to evaluate the CRADLE device for detection of anaemia in Pregnancy. Over fifty percent of pregnant women in India are anaemic – the highest rate in the world – and this increases the risk of pregnancy complications, including preterm delivery and low neonatal birthweight, as well as ongoing health problems in the baby. Early detection of anaemia using the CRADLE device could allow targeted treatment and avoidance of these complications, impacting huge numbers of pregnant women.
Dr Katy Kuhrt MBBS BSc is Research Fellow at the Department of Women’s Health, St Thomas Hospital. For more information on the CRADLE device, or if you would like to purchase one for £20, please contact firstname.lastname@example.org.