Mother & Baby Bond

Problem:

The non-availability of ultrasound services at the village-based health centres or where available, the poor quality of examinations performed, is noticeably more acute with worst maternal mortality indices.

As COVID-19 spread across the globe, in low-income communities, less women turning up for antenatal clinics due to distance, transportation cost and fear of catching or transmitting the disease. Mismanagement of antenatal care and deliveries will increase maternal and neonate morality.

Solution:

There is usefulness of ultrasound in saving the lives of pregnant women who present with obstetric emergencies and conditions. Our experience in the community which shows that a well-organized affordable mobile ultrasound service using portable new/refurbished equipment powered by AI for pregnant women within village-based ante-natal clinics, will make it easily accessible at a reduce cost which encourage antenatal clinics turnout, reduce mortality rate and reduced transmission of infections (as portable equipment are easier to sanitise).

https://www.who.int/reproducti...

https://www.ncbi.nlm.nih.gov/p...

Maternal and neonate mortality rate in Gombe, North eastern Nigeria measures 1549/100000 and 43/1000 respectively, with Nigeria fourth 814/100000 in global ranking.

Inequalities in health service due to poverty as 42% of the national population earn less than 1 dollar a day.

Difficult-to- reach, under-served areas cause a delay in prompt access to facilities where lifesaving equipment and interventions for obstetric emergencies are available.

Delay by the patient or local healthcare provider to present or refer women.

Inability to correctly diagnose an obstetric condition that may require emergency care, due to a combination of lack of suitable equipment like ultrasound machines and dearth of skilled healthcare providers in under-served areas.

Common medical causes of maternal and neonate mortality are pre-eclampsia, placenta previa, premature rupture of membrane (PROM), fetal mal-presentation, multiple pregnancy, unsure dates; are more rampant in the poor communities 68% of which are home deliveries and can be diagnosed easily by ultrasound with average sensitivity of 97%.

We propose routine mobile ultrasound services at affordable prices using portal AI new/refurbished equipment for all pregnant women attending ante-natal clinics in village-based health centres in the North Nigeria in the hope of scaling it up to cover Sub-Sahara Africa.

https://onlinelibrary.wiley.co...

We propose mobile obstetrics ultrasound services using portable AI New/refurbished equipment to pregnant women in village-based ante-natal clinics.

Qualified Radiographers/ Sonographers will go to each centre on antenatal clinic days and perform the examination within their local settings. The use of portable AI refurbished equipment powered by batteries makes it environmentally friendly and easy to use in such settings.

AI software will help to standardise protocol to ensure consistency in image acquisition as well as storage, Tele-medicine for referral pathway/real-time peer reviews using SMS  and e-mails which will be receive through a secure link,  accurate data can be collection for future audits and research and training of community health extension worker (CHEWs) at scale up.

Scan results are issued immediately out to patient and CHEWs for record purposes and advised given based on the result. In case of fetal abnormality and emergencies a copy of the result is also sent by e-mail and SMS to hospital-based clinicians of further intervention.

A minimum of two scans will be carried out routinely as currently agreed by referring clinician, dating and anomaly scans. Third (growth scan) will be performed if required by referring clinicians due to maternal medical history or emergency cases.

Gombe state is predominantly rural with low-income communities, In 2018 over 70% of health facility deliveries took place in rural primary facilities (village -based health centres), none of which offer ultrasound services. Therefore, women must travel to the nearest sub-urban centres kilometres away for ultrasound services increasing the cost and vulnerability to infection (COVID 19).

We are currently running a private diagnostic facility with walk-in ultrasound services in Southern, Gombe State. We are currently working in collaboration with local clinicians, midwives, and CHEWs, in several village-based health centres, sub-urban general and cottage hospitals. 

Recently we have experienced, a drop in number of women attending hospital-based antenatal clinics due to COVID 19, Most women prefer to attend antenatal clinics in their village-based health centres has no ultrasound facilities. We have been approached by community leaders and CHEWs to take our services closer to these women. Our long term solution is  to incorporating ultrasound scans as a routine part of the current free ante-natal care programme in Gombe State and develop a structured referral system for pregnant women who are diagnosed with obstetric complications that require emergency obstetric care.

Challenge: Maternal and New-born Health

Solution:

• Expanding accessibility to high-quality of ultrasound services for pregnant women.

• Using portable mobile new/refurbished equipment makes the service affordable (cost-effective).

• Using AI software will standardise protocols, increasing accuracy and speed.
• Real time tele-medicine to develop a structured referral and peer review  system  get the more qualified Clinicians and Midwives involved in village-based care.
• Good data collection system for audits and research.
• Ability to link mother’s medical history to neonatal records.
• Help mental and emotional health of pregnant women 
• Economic benefit of increased productivity in healthier population group.
• Reduce maternal and neonatal mortality rate.

https://www.philips.com/a-w/ab...

https://www.gehealthcare.com/a...

https://www.ncbi.nlm.nih.gov/p...

In 2017 GE Healthcare partnered with the Nigerian Federal Ministry of Health (FMoH) and the United States Agency for International Development (USAID/Nigeria) on the “Healthymagination Mother & Child Initiative” (HMCI) to reduce the number of preventable child and maternal deaths in Nigeria.

They launched a new mother-and-child health initiative that would expand access to pre-natal screenings to more than 2 million expectant mothers across Nigeria by 2020, incorporating GE’s portable ultrasound Vscan Access. This hand-held machine does not have AI or tele-medicine technology, protocol standardisation, structured referral system or real time peer review difficult.

In 2018 Philips also launched its highly innovative AI powered Lumify with "Reacts mobile" tele-ultrasound solution in Nigeria, although they also targeted the sub-urban and rural areas. However, this solution has not addressed the issue of accessibility in the village-based health settings in Northern Nigeria.

Nigeria has a population of ~ 200 million people, 64% of which live in the rural areas, which means that there is a large market opportunity for our solution. We propose to start carrying out our point-of care services from the rural health care facilities where we work directly with CHEWs who have strong ties to the communities and which is easily access to most families within the communities. This solution will use AI software to standardise protocols, increasing accuracy and speed, as well as real time tele-medicine to develop a structured referral and peer review system for women withing their own settings. 

https://clarius.com/scanners/c...https://www.diagnosticimaging....https://www.signifyresearch.ne....https://www.sor.org/news/deep-...

• The core technology of our solution is AI powered hand-held portable ultrasound machines. 
• AI focuses on increasing productivity and diagnostic confidence as well as improving the ease of use for new users.This image recognition capability is opening the possibility of contextually-aware systems which can assist sonographers in real-time. It can also translate image recognition data into actionable insights that help improve provider efficiency, increase diagnostic accuracy, and personalize treatment. For patients—expectant moms in this case— these intelligent machines could mean shorter exam times and more confident diagnoses delivered quickly to expedite quality patient care.
• Real time tele-medicine will help to develop a structured referral and peer review system where hospital-based Clinicians and Midwives can create pathways for interventions if need be.There also ability to link mother’s medical history to neonatal records.
• The technology has good data collection system for audits and future research.
• Battery powered ans wireless, so no fiddling with cables or USB lead.
• Waterproof and fully immersible for disinfection.
• Works on iOS and Android mobile phones or tablets. 
• It helps with patient scheduling and preparation, Standardising imaging protocols and acquisition, Image and data interpretation  and Reporting and recommendations.

https://onlinelibrary.wiley.co...

https://asoundadventure.wordpress.com/2018/11/04/clarius-to-the-rescue/

https://www.youtube.com/watch?...https://asoundadventure.wordpr...

This solution and the technology has been in used in places like Haiti after the recent earthquake and also in Vanatu: 

• Bringing Portable Ultrasound on a Medical Mission to Haiti, 2018
• ULTRASOUND ON THE GO IN VANATU, 2018

https://www.ghspjournal.org/co...

Immediate/short-term strategy is to set up and provide a mobile ultrasound service to pregnant women in the 4 local government area of southern Gombe State, in their ante-natal clinics.

• Establish a systemic baseline data structure to measure effectiveness of pre and post intervention outcomes.

• Select 6 or 8 remote sites in each of the 4 LGA to deliver mobile ultrasound service during ante-natal clinics.
• Develop and prepare pregnancy information packs in local languages to be given to each woman who attends ante-natal clinic. The information pack will contain pregnancy education leaflets (using texts, pictures and drawings), a picture folder for ultrasound picture of the baby (to promote mother-to-child bonding).
• Procure specially adapted project motorbike/vehicles, portable hand-held ultrasound machines and other ancillary equipment. Carry out systems test-run before full, phased, implementation.
• Continue our working relationship with General and Cottage Hospitals in the 4 LGA by developing a structured referral system for pregnant women who are diagnosed with obstetric complications that require emergency obstetric care.
• Recruitment of suitable employees and provide training so that high quality ultrasound services can be continually available.
• Establish an innovative information dissemination, advocacy and publicity strategy targeting women, community and faith-based organizations to popularise the project and encourage programme uptake amongst the target population and their families of the availability of ultrasound at their antenatal care clinics which will also Increase health facilities deliveries.
• Tremendous boost to efforts at reducing maternal and child mortality rate in Gombe State by 2015 Millennium development goal (MDG) 4 and 5.
• Increase women population for economic productivity.

Long-term goal, for our solution is to scale up these processes by incorporating ultrasound scan as a routine part of the current free ante-natal care programme in North east of Nigeria and Sub-Sahara Africa.

• Get full value for money with this innovative, which may also attract funding by local and international development partners in the long term.
• World class training to be provided to healthcare workers who will eventually take over and run the programme.
• Tremendous boost to efforts at reducing maternal and child mortality rate globally (MDG goal 4 and 5).

https://www.ncbi.nlm.nih.gov/p...

http://www.citypopulation.de/php/nigeria-admin.php?adm1id=NGA016

https://www.worldometers.info/world-population/nigeria-population/

Gombe state population is currently 3, 257,000 with a yearly growth rate of ~2.64% estimated.

47.4% of the state population are women. Seventy-two percent of women had attended at least one antenatal care visit during their last pregnancy.

We our services currently cover 4 local government areas with population of 999,100 people in total, to include Kaltungo: 220,900; Billiri: 279,100; Balanga: 291,200 and  Shomgom: 207900 .

Of these population 473,573 are women, 72% of which attended antenatal clinic at least once.

We are currently serving 340,972 women.

With an estimated yearly growth rate of 2.64%, these will increase to ~347974 women in 1year and ~ 385982 women in 5years.

https://www.citypopulation.de/...

Our goal is reduced maternal and child mortality in the North east Nigeria, Nigerian and Sub-Shara Africa by incorporating AI powered, portable hand held ultrasound scan as a routine part of the ante-natal care in the rural areas, in order to achieve goals 4 and 5 of the (Millennium Development Goals) MDG.

In the next one year, we to intend implement the Ist phase of our solution by scaling up our services to other all the 11 LGAs in Gombe State, Taraba, Bauchi, and Central and South Adamawa States. (Total population of ~14, 178, 200). We plan to carry -on with the working relationships we had developed with the State Governments, Local Government Areas, General and Cottage Hospitals, Ministry of Women Affairs and/or Ministry of Health and Community and faith-based organizations.

The 2nd phase will start in the 3rd year by extending our scale up to the rest North east Nigeria (North Adamawa, Yobe, Borno State), We are hoping to start in the Internally displaced people (IDP) refugee camps in these regions. However, this is going to be with caution due to present insurgencies by Boko Haram in these areas. We hope to achieve this by work partnering with NGOs, State and Federal Security agencies, State Governments, Local Government Areas, General and Cottage Hospitals, Ministry of Women Affairs and/or Ministry of Hhealth.

In 5years we hope to be able to extend our services to the neighbouring countries like Chad, Cameroun, and Niger Republic.

• http://www.tjogonline.com/ar...

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• Socio-cultural and religious factors: In the developing countries especially in the rural areas, some women do not attend antenatal facilities because of deeply held cultural beliefs and/or tribal traditions surrounding the nature of pregnancy and childbirth. This is often due to the added problem of ignorance of options for mitigating the consequences of mismanaged care of the fetus born with congenital anomalies.
• Lack of ancillary services: The ability to make complicated fetal diagnosis is a waste if no clinician or facility to treat the patient is available. In settings where these services are not available, there should be provision for transfer of a high-risk pregnancy to a regional obstetric centre where the services are available.
• Inadequate training on newly purchased equipment and Unskilled operator:.
  The WHO scientific group has stressed in its report, "the need for appropriate training for general practitioners and specialists meant to use US. To optimize the use of such equipment, a sonographer or sonologist should be trained on the same type of machine that he is going to use in routine practice".
• Lack of maintenance culture in most developing countries: "The quality of US images deteriorates with use, thereby limiting the detection of fetal anomalies. Most pieces of equipment are purchased with little or no service and maintenance contracts, such that they are abandoned for relatively trivial faults which would have been amenable to easy repair with appropriate maintenance contracts".

• Financial support and sponsorship
• Insurgency and communal clashes

We have developed a strong solution policy of “working with partner at all levels of operation”

• Sociocultural and religious factors

We will continue to encourage our policy on partnering with and faith-based organizations, Ministry of Women Affairs and/or Ministry of Health and General and Cottage Hospitals.

• Inadequate training on purchased equipment and unskilled manpower

All our Sonographer are full trained qualified Sonographers and registered with the necessary regulatory bodies. 

To optimize the use of the portable hand-held equipment, our Sonographers will be trained on the same type of equipment they are going to use in routine practice.

Our solution equipment has AI software which will help to standardise protocols, it comes with unlimited tele-medicine which works on iOS and android Apps.

• Lack of maintenance culture in most developing countries

We will be using simple, portable, and handheld, minimizing the resources needed for servicing and maintenance. Necessary care package will be purchase with the proposed equipment, which include accidental damage protection, up-time protection, Hospital theft protection and return merchandise authorization.

• Financial support and sponsorship

We have been able to sustain our service for 9years through direct sales to customers and personal savings, but for growth and expansion we are applying for grants and donations to boost our financial support.

• Insurgency and communal clashes

We will be partnering with State and Federal Security agencies, NGOs, Ministry of Women Affairs and/or Ministry of Health and community and faith-based organizations. While using our monitoring, evaluation, and programme learning.

Trimxell Limited: (Medical Consultancy and Diagnostic services)

For medical diagnostic services: Kaltungo Diagnostics (Mother and Baby bond)

10 Full time staff

2 part-time

• 4 Radiographers/Sonographers.

Two Radiographers / Sonographers are indigenes of Gombe State who had the opportunity to train and work in the United Kingdom as with a collective work experience in the UK of about 18 years, 9 ears experience of setting up and running a private diagnostic facility in Kaltungo, Gombe State, where we have experienced first-hand, the usefulness of ultrasound in saving the lives of pregnant women who present with obstetric emergencies and conditions.

The other two Radiographers/Sonographers work and trained in Nigeria. They have 4 and 1years experience rural settings in the North central and North east of Nigeria respectively.

• 1 Laboratory Technician
• 1 Radiography Technician
• 1 Accountant
• 1 Computer Operator
• 1 Cleaner
• 3 Security Guards.

None

Since March 2011 we set-up and run your services by raising investment capital through our personal savings, contribution from family members and selling our services directly to customers.

In order to scale up our solution and achieve our goals in the next few years, we need more than sales of service that is the reason why are trying to a combination of direct sales of services, bank loans, donations and grants to raise funds.

• We would like to join a supportive community of peers, funders, and experts to help advance our solution.
• We want partners that will give us strategic advice, mentor-ship, technical expertise, media and conference exposure, and business and entrepreneurship training.

• Partnering with others may also bring knowledge and experience we may be lacking, or complementary skills to help our growth.

• The right business partners may also enhance your ability to borrow money to finance the growth of the business. 
• A partner can inspire us and even move us from apathy to the exhilaration of exploring new possibilities. 
• We would also like to partner non-profit organizations and government entities who had similar experience in maternal and child health.

• We would like to join a supportive community of peers, funders, and experts to help advance on how to raise more funds for our solution.
• We want partners that will give us strategic advice, mentorship, technical expertise, media and conference exposure, and business and entrepreneurship training.

• Partnering with others may also bring knowledge and experience we may be lacking, or complementary skills especially in monitory and evaluation our solution during the second phase (Scale up).

• We would like to work with partners like MIT’s initiatives through their educational objectives of creating applied international learning opportunities for MIT students that increase their ability to understand and address real-world problems.
• Also, through their Bolsters the Institute’s research mission which promotes collaborations between MIT faculty members and their counterparts abroad.

https://childvoice.org/all-blo...

https://childvoice.org/how?gcl...

https://childvoice.org/why?gcl...

Expanding our solution to in Borno, Yobe and Adamawa states in Nigeria, regions of

Boko harm insurgency which has caused distributing of lives and displacement of people especially young and women from their home. We hope to start in Internally displace peoples camp IDP. More than 80% of these displaced persons in northeast Nigeria are women and children. Among them, adolescent girls and child mothers are traditionally overlooked by humanitarian programs. 

Due to a decrease in food distribution within the IDP camps, girls are being married off at younger ages than ever—as young as 12 and 13—to reduce the economic burden on their parents and generate revenue from the bride price.

Most of these girls are particularly vulnerable to abuse, exploitation, and forced labour. Tragically, girls are being exploited at earlier ages and for progressively more brutal uses, such as sexual slavery, chattel for trafficking, and as armed combatants. This exploitation of girls often precipitates a two-generation impact – the girl herself and the children she bears.

Our desire is that through our solution these pregnant adolescent girls will receive free ultrasound scan in the health centres within the refugee camps.

Our aim is to use the solution a bonding process for these adolescent mothers are their babies, help mental and emotional health of these adolescents with the economic benefit of increased productivity in healthier population group.

Expanding our solution to in Borno, Yobe and Adamawa states in Nigeria, regions of

Boko harm insurgency which has caused distributing of lives and displacement of people especially young and women from their home. We hope to start in Internally displace peoples camp IDP. More than 80% of these displaced persons in northeast Nigeria are women and children. Among them, adolescent girls and child mothers are traditionally overlooked by humanitarian programs. 

Due to a decrease in food distribution within the IDP camps, girls are being married off at younger ages than ever—as young as 12 and 13—to reduce the economic burden on their parents and generate revenue from the bride price.

Most of these girls are particularly vulnerable to abuse, exploitation, and forced labour. Tragically, girls are being exploited at earlier ages and for progressively more brutal uses, such as sexual slavery, chattel for trafficking, and as armed combatants. This exploitation of girls often precipitates a two-generation impact – the girl herself and the children she bears.

Our desire is that through our solution these pregnant adolescent girls will receive free ultrasound scan in the health centres within the refugee camps.

https://www.ncbi.nlm.nih.gov/p...

In Nigeria, the practice of child marriage is deeply entrenched in tradition, culture and religion and the country has one of the highest rates of child marriage in the world, with estimated 42% of girls married before 18 years; and while this is found among many ethnic groups across the country, its predominance is clearly in the Northern part of the country. While nation-wide, 20% of girls are married by age 15 and 40% are married by age 18, child marriage is extremely prevalent in some regions such as among the predominantly Muslim Hausa-Fulani of the Northwest and North-East where 48% of girls are married by age 15, and 78% are married by age 18.

Studies carried out has already identified the negative impact of early marriage on young women in Nigeria, expressed in form of high maternal mortality through various pregnancy complications in the study areas.

Our solution is design to reduced maternal and neonatal mortality rate in the North-East of Nigeria by using AI powered portable that produces real time images for tele-medicine. These are point-of -care services using mobile ultrasound machines  in village-based health care facilities to incorporate ultrasound scans as a routine part of the current free ante-natal care programme and to develop a structured referral system for pregnant women in the North-East Nigeria.

If our solution is successful, it will help to improve mental and emotional health of these pregnant adolescent with the hope of increased productivity in healthier population group.

https://support.clarius.com/hc...

https://support.clarius.com/hc...

• The core technology of our solution is AI powered hand-held portable ultrasound machines. 
• AI focuses on increasing productivity and diagnostic confidence as well as improving the ease of use for new users.This image recognition capability is opening the possibility of contextually-aware systems which can assist sonographers in real-time. It can also translate image recognition data into actionable insights that help improve provider efficiency, increase diagnostic accuracy, and personalize treatment. For patients—expectant moms in this case— these intelligent machines could mean shorter exam times and more confident diagnoses delivered quickly to expedite quality patient care.
• Real time tele-medicine will help to develop a structured referral and peer review system where hospital-based Clinicians and Midwives can create pathways for interventions if need be. It also can link mother’s medical history to neonatal records.
• Training opportunities for Clinicians, Midwives, Radiographers/Sonographers and CHEWs. App iCloud which supports reviewing of images and sharing interesting cases with Clinicians, and for peer reviews.
• The technology has good data collection system for audits and future research.
• Battery powered and wireless, so no fiddling with cables or USB lead.
• Waterproof and fully immersible for disinfection.
• Works on iOS and Android mobile phones or tablets.

Our goal is reduced maternal and child mortality in the North east Nigeria, Nigerian and Sub-Shara Africa by incorporating AI powered, portable hand held ultrasound scan as a routine part of the ante-natal care in the rural areas, in order to achieve goals 4 and 5 of the (Millennium Development Goals) MDG.

In the next one year, we to intend implement the 1st phase of our solution by scaling up our services to other all the 11 LGAs in Gombe State, Taraba, Bauchi, and Central and South Adamawa States. (Total population of ~14, 178, 200). We plan to carry -on with the working relationships we had developed with the State Governments, Local Government Areas, General and Cottage Hospitals, Ministry of Women Affairs and/or Ministry of Health and Community and faith-based organizations.

The 2nd phase will start in the 3rd year by extending our scale up to the rest North east Nigeria (North Adamawa, Yobe, Borno State), We are hoping to start in the Internally displaced people (IDP) refugee camps in these regions. However, this is going to be with caution due to present insurgencies by Boko Haram in these areas. We hope to achieve this by work partnering with NGOs, State and Federal Security agencies, State Governments, Local Government Areas, General and Cottage Hospitals, Ministry of Women Affairs and/or Ministry of Health and Community and faith-based organizations.

In 5years we hope to be able to extend our services to the neighbouring countries like Chad, Cameroun, and Niger Republic, by continually working with and partnering with NGOs, State and Federal Security agencies, State Governments, Local Government Areas, General and Cottage Hospitals, Ministry of Women Affairs and/or Ministry of Health and Community and faith-based organizations.