Maama Monitor

A device to monitor pregnant mothers daily for early signs of severe hemorrhage, hypertension, infections, to prevent delays in seeking and receiving medical care hence reducing maternal mortality in Uganda.

With Maama Monitor, we seek to reduce the Ugandan maternal mortality rate by reducing a delay by pregnant mothers to recognize danger signs and make a decision to seek medical help, and the delay by clinicians to respond to derangements in vital signs of admitted mothers. We are looking at reducing deaths resulting from severe hemorrhages, hypertensive disorders, puerperal sepsis, and infections which are the four leading causes of maternal mortality in Uganda.

Maternal mortality is defined by the World Health Organization as the death of a woman from pregnancy-related causes during pregnancy or within 42 days irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes, expressed as a ratio to 100,000 live births in the population being studied.

In March 2021, the Uganda Bureau of Statistics reported that the maternal mortality rate was 368 deaths per 100,000 live births which is still far above the global average; 152 deaths per 100,000 live births in 2020.

 According to The National FY 2020/2021 Annual Maternal and Perinatal Death Surveillance and Response Report, 42% of all the maternal deaths reviewed were due to hemorrhages. This was followed by hypertensive disorders of pregnancy (15%), indirect causes including malaria, HIV/AIDS, severe anaemia, and other infections (12%), pregnancy-related sepsis (10%), abortion Complications (7%). The remaining 14% was contributed by other causes

Maternal mortality in Uganda has been attributed to the “3 delays”: delay in deciding to seek care, delay in reaching care in time, and delay in receiving adequate treatment.

The first delay is on the part of the mother, family, or community not recognizing a life-threatening condition to seek skilled care in time. The maternal deaths arising from the first delay are commonly due to ignorance of pregnant mothers about the symptoms of these conditions, inadequate monitoring of mothers for early signs of the conditions, as well as lack of partner support in making timely decisions to access a health facility.

The second delay entails challenges in women accessing a health facility due to lack of transport from home to facility, and between facilities due to lack of ambulances, whereas the third Delay usually arises from delayed intervention at the health facility due to inadequate monitoring of admitted mothers, lack of essential drugs like anticonvulsants [Magnesium Sulphate], drug stock- outs, misdiagnosis, lack of blood products.

According to a study in West Bengal, India about the three delay model to assess social-cultural barriers associated with maternal death in low and middle income countries, Type 1 delay was the most significant contributor to maternal deaths (48.6 percent, 154/317). Type 2 delay contributed 33.8 percent, 107/317 and Type 3 delay; 18.9 percent  (Md Illias Kanchan Sk et al, 2019)

With Maama Monitor, mothers shall seek care time, and have timely intervention in case of derangements in vitals while admitted, hence reduced mortality from preventable causes.

Maama Monitor is a patient-centered monitoring device for pregnant women that works with a mobile application. Using a cuff with an embedded temperature sensor, the device automatically measures the mother’s blood pressure, pulse rate and temperature. It calculates the shock index (pulse rate /systolic blood pressure. Shock index can detect a possibility of shock before blood pressure drops). It then wirelessly transmits the results to the mobile application where they are displayed. Therefore, hypertensive disorders of pregnancy, shock from severe hemorrhage or sepsis or an infection can be detected early.

The blood pressure, shock index and temperature readings are displayed against a color scale with expressive emojis to help the pregnant woman understand the significance of the reading. This information is also sent to the next of kin’s phone. It is also shared and viewed from a system at the health care facility where they can access information about the different mothers under their care.

 In the event that there is a derangement in any of the parameters, an alarm is made on all respective devices. USSD codes shall be used for phones not connected to internet. Therefore, spouses participate in the pregnancy's close monitoring, better connection with the healthcare providers, hence the decision to seek medical care is quickened.

The daily records are stored and can be retrievable on the application at any time. The application shall recommend nearby healthcare facilities that provide maternal services depending on the mother’s location. It will also provide pregnant mothers with educational maternal health information in order to ensure smooth maternal care.

The device is made with low-cost 3D printing, rubber tubings, simple microcontroller managed electronics such as servo motors, temperature and pressure sensors nylon material for cuffs. It will be powered by rechargeable batteries (can be recharged using solar and hydro power).

The Maama Monitor is a device created to serve  both expectant and postpartum mothers in a bid to reduce maternal mortality and morbidity due to preeclampsia, ante- and postpartum hemorrhage as well as febrile illness that greatly affect them.

Most maternal deaths occur among mothers who present late, already in critical conditions or those who delay to receive care at facilities. Late presentation at facilities is usually due to a delay to make a decision to seek health care mostly because the mothers do not know that they are in danger due to inadequate monitoring or due to transportation delay. 

Currently, pregnant mothers in Uganda attend antenatal care once a month, with their vital signs taken only during these visits. This leaves a risk of life threatening events such as eclampsia happening from home due to undetected preeclampsia among other potential risks.  Due to inadequate staff in most health centers, there is unsatisfactory inconsitent monitoring of mothers for any deranged vital signs that may require immediate intervention during admission. All this leads to preventable maternal deaths.

We believe that this innovation will be helpful to these persons because it will render them active participants in monitoring their wellbeing along with spouses and caretakers. By monitoring their vitals during the period of pregnancy, there will be early detection of predisposition to danger of either the mother or child. This will facilitate early decision making to seek medical attention, early diagnosis which will also give a time allowance incase services are not readily available so that options for referral or getting an alternative is obtained before the situation becomes critical.

The device will be relatively inexpensive and designed for easy use with an alarm system that will be able to alert the expectant mother in case there is a life threatening derangement in their vitals. The information collected from the mothers will be directed to their various health care giving centers  through a mobile app that will help keep track of the mother(s) well being (through routinely taking and reporting vitals) and the mother(s) will be approached by the health workers in their places of comfort, be it home or the health centers.

The Maama Monitor is a fruit of interdisciplinary efforts to solve a challenge that has multi- dimensional implications. The intimate ideals held by us are rooted in a One Health Approach which is a conduit of integrated multi-disciplinary effort to obtain optimum health for all. Each choice member is dominating transformational roles in the education of our community and revolutionary systems that are put in place. Hence, we have all been trained in aspects of causing change like communication, advocacy and project management and development in order to make a contribution to the general wellbeing of everyone, especially expectant mothers. Our team is composed primarily of three passionate doctors, a biomedical engineer, a software engineer as well as a gender specialist. We all have a history of being the positive change that’s oftentimes sought for by many.

MEET THE TEAM:

When passion meets will and begets extraordinary results, you always want to see the force behind it all. Kobusingye Mercy is a doctor awaiting the honors of the Bachelor of Medicine and Surgery from Mbarara University of Science and Technology. She is currently volunteering at Ibanda Martrys’ Hospital, Ibanda where she is actively involved in the management of pregnant mothers affected by conditions such as preeclampsia which we are actively handling through our innovation. She has exercised prowess as an innovator retrospectively founded whilst she served as a Vice President of the Robotics Club at Maryhill High School. She also  recently led her innovation team to championship at the 8th CamTECH Uganda Hackathon in which she was recognised as of the champion team at Camtech Uganda 8th hackathon,  and best presenter of the hackathon. She is a public speaker, with a great ability to sensitize masses.

She is also the Secretary for Female Affairs on a Kiruhura District youth committee, directly engaging in matters affecting female youth in the district, early pregnancies with the associated risks of death for the young mothers being one of the most significant. To this effect, she ran a campaign against teenage pregnancies and early marriages following the Covid-19 school lockdown that saw many girls die due to these conditions, validating the need for this innovation even for the younger mothers. 

Aringo Ramona Noeline is  a medical Pre-intern awaiting the honors of the Bachelor of Medicine and Surgery from  Mbarara University of Science and Technology. She is a Global Health Scholar 2021,  and a HEPI-TUITAH training in HIV/AIDS care and treatment . She is  passionate about maternal and child health and has actively participated in activities that involve maternal health through volunteering Rwekubo Health Center IV in Isingiro.

Our lead innovator is Mbulambago Timothy, a biomedical engineer with experience in Design Thinking Approach for solving community problems, 3D designing, building circuits and use of sensor technologies. He has developed devices and software for healthcare including a non- invasive glucose monitor which was the best Hackathon Innovation awarded during the 8th annual hackathon hosted by CAMTech. He developed a registry database for cancer patients at the Uganda Cancer Institute in partnership with Johns Hopkins University.  He has also developed a remote monitoring device for children with cerebral palsy during his internship at Ruharo Mission Hospital with Organized Useful Rehabilitation Services (OURS) in Western Uganda. These have provided him with the proper skill set for the designing and development of the Mama Monitor System.

Dr. Andrew Mutekanga, our consultant, is a non- communicable disease   prevention and treatment champion with 5 years of volunteering experience treating Diabetes and Hypertension. He is currently a  finalist student for Master of Medicine in Internal medicine. He also serves as technical advisor to the Mbarara and Kinoni Diabetes patients association. He has strongly pointed out that one of the main challenges in the settings of his work is the lack of monitoring devices to facilitate self home management in care and link to hospital care.

Myers Turyahabwe, the team programmer and software developer is a third year software engineering student, CAMTECH innovator, did internship with Payroll Consult Africa limited. He worked on online shopping mobile application development (Tutumie) during his academic internship.He served as the President of the Mbarara University Debate Society 2022- 2023. He is an active member of the Google Development Club, Mbarara University of Science and Technology.

Our team leader is Vanessa Kimuri with a major in Gender and Applied Women Health. She worked with the MUST Peer Project as The project secretary of the "She Decides Project" on Civil Rights and Social Action at Mbarara university of science and technology. Vanessa actively participated in the  "She Decides hub" in providing  information to students about family planning, sexual and reproductive rights to students. This has given her experience in Human Relations and Development Studies which we hope are crucial in driving this project forward to have the greatest impact in the community. 

We are firstly Ugandans, born and raised from various parts of the country. At the core of our solution are lived experiences of our very own lives and of the environment in which we have been groomed. From burying loved ones to losing great women and babies whose lives we never got to behold,we have each at individual levels been directly or indirectly affected. Great or small, maternal mortality has robbed them all.

Whilst  many of us have not yet borne any child yet, we are also potential users of our own device.

Three of our members are medical students, who have had their training at Mbarara Regional Referral Hospital, the biggest hospital in the western part of Uganda and have directly taken part in the management of mothers affected by these very conditions who came in late for treatment because of the delays discussed above, that we believe will be solved once our product is developed and used.  

By this very opportunity, we have been privileged to observe the undertakings of the recently concluded and published research at Mbarara Regional Referral Hospital on implementation of wireless continuous vital sign monitoring after cesarean delivery in Uganda by Adeline. A. et al, 2023. This has showed great success for mothers in the hospital. Hence we share optimism that with our community based Maama Monitor, early decisions to seek care will greatly reduce maternal mortality.

As young change makers, participation in various hackathons by CamTECH Uganda and design thinking workshops with Centre For Innovation and Technology Transfer (CITT) at Mbarara University of Science and Technology have equipped us with skills with which our problem solving instincts were heightened and groomed. Hence, the making of the mama monitor.

The solution is innovative with the following functionalities;

• Self monitoring of the mother: For a long time in Africa, medicine has been hinged to the health workers. With Mama monitor, we are empowering mothers to engage in their care, reducing costs and the burden on the healthcare system 

• With the measurement of blood pressure, temperature, pulse rate and calculation of shock index, we shall be able to detect early and diagnose  hypertensive disorders of pregnancy, impending shock hemorrhage, and an infection. Hence, there will be an early decision to seek care as well as timely intervention in case derangement of vital signs of admitted mothers 

• A timely alarm system alerting of the pregnant mother, the healthcare facility as well as their partner about the health threats mentioned above, hence timely seeking of care and intervention 

• The device shall be easy to use with a user friendly interpretation of results that does not require technical or medical knowledge

• Reduced cost of healthcare services through; monitoring of mothers at home, reducing costs of delay due to emergency costly interventions 

• Low cost of design and fabrication of the device. It uses.( Readings taken at home, spending). The device is made using low cost 3D printing technology, rubber tubings, simple microcontroller managed electronics such as servo motors and pumps for cuff inflation, temperature sensors, pressure sensors and nylon for the cuffs. This makes it possible to locally make the device at an affordable cost 

1.       We plan to have finished prototyping by the end of June 2023 with the leading of the team’s software and biomedical engineers.

2.       As of August 2023, we intend to have authorized approvals from the National Drug Authority to use the device in the Ugandan health system by meeting guidelines and requirements at hand.

We shall do this through partnerships with the ministry of health and National Drug authority itself.

3.       In September 2023, we shall start running a pilot study with a workable prototype on high risk mothers for pre-eclampsia, antepartum and post-partum hemorrhage and sepsis at Mbarara Regional Referral Hospital high risk clinic. This shall be completed by February 2024.

  We shall do this by partnering with the administration of Mbarara Regional Referral Hospital and the mothers that attend the high risk clinic

4.       By April 2024, at least 20% of Ugandan women in the reproductive stage shall know about Maama Monitor and its use in promoting maternal healthWe shall do this through advertisements on social media and other media houses such as Vision Group Uganda, National Television (NTV); different local radio stations, and telecommunication companies such as MTN and Airtel.

5.       In June 2024, we shall roll out the first device on the market in Uganda to be used in partnership with the  Ministry of Health, private pharmacies, and pharmaceutical bodies in the country 

6.       By December 2024, we plan to have reached at least one percent of pregnant women (13,315 women)  in Uganda. This we shall do by partnering with the ministry of health, United Nations High Commission for Refugees (UNHCR) for the women in refugee camps, different private non for profit and private for profit hospitals, pharmacies in Uganda.

The Maama Monitor is categorized under the Remote Monitoring and Automated Healthcare Technology.

The system consists of a wireless upper arm cuff that syncs with a smartphone using wireless connection  and is an automated oscillometric device. Systolic and diastolic pressure readings are determined by the device by recording vibrations in the arterial wall.

On every user, the device uses fuzzy logic to determine how much air should be pumped into the cuff to raise the pressure to about 20 mmHg above systolic pressure. When the cuff is fully inflated to this pressure, the artery is completely closed to blood flow. The artery is allowed to open up and allow blood to flow through it as the cuff is deflated below the systolic pressure, which causes an audible vibration in the arterial wall.

Blood flows normally through the artery in the typical pulses when the cuff pressure falls below the patient's diastolic pressure. There is no vibration created in the wall. Any time the cuff pressure is high enough for the blood to have to push the arterial wall open in order to pass through the artery, vibrations take place.

Through the air in the cuff, the vibrations are transmitted from the arterial wall to a transducer in the monitor, which transforms the readings into electrical signals.

From these  the blood pressure and pulse rate can be obtained and  shock index calculated.

In order to measure the body temperature, the device uses a temperature sensor that is embedded into the cuff.

According to the Uganda District Health Information Software 2 (DHIS2), approximately 1,331,484 mothers gave birth in the 2020/2021 financial year. This gives an approximate number of 13,315 women, firstly targeting the high risk mothers for hypertensive disorders of pregnancy, antepartum and postpartum hemorrhage and puerperal sepsis. 

Currently, our solution is not serving any people since its still at concept stage. By the end of next year, we hope to be serving at least 13,315 pregnant women which is approximately 1% of the pregnant women.

This innovation is one that has the potent ability to greatly minimize preventable causes of maternal death embedded in the three delay model by providing consistent monitoring of asymptomatic indicators of underlying conditions to hypertension, hemorrhage and infections. The Mama Monitor through a  mainstream approach will excel in the detection and prevention of risks related to pregnancy and the mitigation of effects of crises 

With the successful and highly needed design of the Mama Monitor, this innovation will ensure simplified monitoring of critical vital indicators and redirection of interventions addressed to combating maternal mortality. The  of the Maama Monitor is may be deterred by the following:

• Financial Inclusion

Whilst the Maama Monitor uses readily available resources within our community to create our prototype and final device, the challenge is to have access to the necessary funding to put up structures necessary for the successful production and distribution of the Mama Monitor.

Our Project is still at concept stage and progressively transitioning to prototyping at a controlled scale until approved by authorized bodies. Therefore, there is a need for investment towards production, certification and distribution of  the devices to the intended users. Therefore, initial financial support is needed to boost progress in development and production.

• Technical Inclusion

For many decades, people have almost exclusively relied on medical health personnel as the sole health care system operators with the power to make decisions for them. This innovation is one that enables patients to actively wield decision making collaboratively. However, a mindset shift is required in order for this innovation to be fully utilised.

•  Bureaucracy

The registration process for medical devices in Uganda requires rigorous testing and evaluation. Some of the regulation standards have to be tested from outside Uganda that makes the whole process tiresome. This also involves acceptability in the healthcare facilities since it will disrupt the workflow.

• Publicity and awareness.

In order to bring a new device on the market, there needs to be comprehensive outreach to the end users. This will require intensive labor to reach out to pregnant mothers in healthcare facilities, as well as education on the importance of the new device which demonstrates a paradigm shift on management of pregnancy.

As of now, we have not yet partnered with any organisation but we are actively engaged in bringing on board the following potential partners: 

• CAMTech Uganda

• Mbarara Regional Referral Hospital

• The Association of Obstetricians and Gynaecologists of Uganda

 Our target users are pregnant women in Western Uganda who face a risk of hypertensive disorders such as preeclampsia, shock hemorrhage and infections that can result in death due to delay in detection and management of such conditions. By this virtue, high risk mothers, their caretakers and loved ones as well as health care service providers will be customers and consumers for this product.

Our value proposition is that:

• We are offering patient centered care in which the mother as well as their caregivers can monitor the pregnancy from home while the health worker can remotely monitor the same mother. By this, the expecting mother and her caregivers are better positioned to make informed timely decisions. This is the same for the health care service provider who is given extended ability to monitor one’s patients in and away from a healthcare center. In case non-compliance is observed from the patient, action can be taken including reaching out to the patient for review . Hence, we can achieve reduction of deaths due to quickened response of clinicians to mothers.

• Early detection and consistent monitoring of hypertensive disorders, shock hemorrhage and infections in high risk mothers will enable better management of complications.

• The Maama Monitor wil be mounted with  timely alarm system to the mother, partner/caregiver as well as the healthcare facility for a timely intervention.

• Low cost maternal healthcare service through providing more control in the management of pregnancy related complications through predicting the possibility of emergency situations that require timely interventions. Our customers will be able to handle emergencies in time.

• Reduced mortality of pregnant mothers

In the first year of production , distribution and usage, we shall

• Reach out to at least 1% of the pregnant mothers in Uganda , hence serving and impacting at least about 13,000 pregnant mothers.
• Provide access to maternal health information to pregnant women, spouses and caretakers through the mobile application.
• Provide continuous self monitoring of the mother and use of data collected over time to be used to make informed decisions.

Our key activities of focus afrer production shall be: 

• Marketing and sales of the Maama monitor device.
• Customer management through getting customer feedback from users and other stakeholders.

Key channels for reaching out to our customers:

• Making direct sales at maternal healthcare facilities to pregnant mothers 
• Use of sales agents 
• Online advertisement through social media platforms

Future prospects :

• When we get a surplus from sales, we hope to do the following
• Expansion of the areas of coverage to cover all regions in Uganda through increasing production 
• Provide free maternal health education and sensitisation to the community as a form of corporate social responsibility 

• Grants and donations are necessary for us to  firstly establish prototyping, research and appraisal for our product in order to kick start production, marketing and distribution of our product. The goal is to finance the initial start up of production so that it hits the ground running.

• Through partnerships with Government Aided Hospitals, Private Hospitals as well as Private non-profit, we hope to engage our stakeholders in production and distribution/ selling of the Maama Monitor with a Return-On-Investment policy that allows for gains to be obtained by our potential investors while our primary objective of reducing maternal mortality is achieved. If this works, investment margins and shares shall increase to pool more funding for production.

•  Revenue will be generated from direct sales of the Maama monitor. This revenue will be used for expansion and production of more devices to  further expand the market.