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Photo: PATH/Gabe Bienczycki Preterm birth complications are the leading cause of death for children under five years of age. Survival rates, particularly for babies born extremely premature (three months early), can vary drastically from 10 percent in low-resource settings to 90 percent in high-resource settings. While many babies are born in low-resource settings, outside of hospitals, and without access to high-tech interventions, it is still possible to provide the basic care many preemies need to survive. For example, a number of low-cost innovations and interventions, such as breathing support and clean cord care, have the potential to slash newborn mortality. GHTC member, The Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), in partnership with Project Concern International and the American College of Nurse Midwives, has received a five-year, US$9 million grant from the US Agency for International Development for the Every Preemie—SCALE initiative to identify lifesaving interventions for the prevention and treatment of preterm birth and low birthweight and to support the scale-up of these interventions in 23 countries across Asia and Africa. To learn more about GAPPS’ work on the Every Preemie—SCALE initiative, we’re joined by Dr. Jim Litch, director of the Perinatal Interventions Program at GAPPS. Q: Central to the Every Preemie—SCALE initiative is research to identify evidence-based solutions for the treatment and management of preterm birth and low birthweight. What’s been done so far and what key findings are emerging? A: Ideally, pregnant women should have access to prenatal care, which is particularly important for women at risk of preterm birth who need particular prevention services and care interventions. Far too often, however, prenatal care is out of reach for families, of poor quality, or does not include the special needs for preterm births and preterm newborn care. Preterm birth has only recently received attention from the global health community, and there are many emerging opportunities to learn from current efforts to expand maternal and newborn health programs to include preterm birth prevention and care content. Preterm babies have different needs than full-term babies, and recognizing this helps us develop tools and interventions across the continuum of care. Just this month, accurate growth curves for weight, length, and head circumference for healthy preterm babies born as a single birth were published to complement existing growth standards for full-term infants and provide new, accurate standards for fetal growth. Through Every Preemie, GAPPS is supporting implementation research with local partners in Bangladesh, Ethiopia, India, and Malawi. In Bangladesh, we are testing a simple method of estimating gestational age during pregnancy using a tape measure and weight scale. In Ethiopia, we are evaluating implementation of preterm birth services within multi-partner maternal and newborn health programs across the continuum from the community to district hospital level in different living contexts (settled, semi-settled and urban). In India we are preparing to assess the safe use of antenatal corticosteroids (ACS)—which have been shown to reduce preterm birth complications—among women in imminent preterm labor, including pre-referral first dose of ACS administered by auxiliary nurse midwives. And in Malawi we are investigating the effectiveness of a comprehensive community mobilization approach designed to better link communities to preterm-related health services from the household to the facility level. A recurring finding from the implementation and research communities is that context is critical. What works well in one setting may not work well in another. This is a lesson that returns to us time and again. Standardized outcomes and robust descriptions of the settings from which evidence is obtained create a greater burden on research, evaluation, and program resources. Q: Can you talk a bit about some of the technologies identified as potential solutions under Every Preemie? And what characteristics make a product or intervention realistically scalable in low-resource settings? A: Infant death and morbidity following preterm birth can be reduced through interventions provided to the mother before and during pregnancy, including the period around delivery, and to the preterm infant after birth. The most beneficial set of maternal interventions are those that could improve survival chances and health outcomes of preterm infants when preterm birth is inevitable. In August 2015, the first World Health Organization recommendations on the Interventions to Improve Preterm Birth Outcomes were issued. These recommendations provide important guidance on interventions and related technologies that could be provided during pregnancy, labor, and the newborn period with the aim of improving outcomes for preterm infants. Understanding the demand for services is of critical importance when working to realistically reach scale in low-resource settings. This includes a need to better understand the knowledge, attitudes, and perceptions of families around preterm birth and preterm newborns in individual communities and settings, as well as the demand created by care providers within existing maternal, newborn, and reproductive health service delivery systems. Now more than ever, improvement in preterm outcomes requires a truly integrated approach. Q: What role will advocacy—whether at the global, national, and local level—play in advancing the innovations and interventions identified through Every Preemie? A: Advocacy is fundamental at all levels for real, lasting change. Moving a community to success can be accelerated by advocacy. When professional organizations, parent groups, economists, and others all demonstrate the effects of quality prenatal and newborn care, governments will institute policies to provide not just for the wealthy but also for the most vulnerable. The best interventions, products, and services can have impact on preterm survival only when the required attention and ongoing needs are continuously met for these highly vulnerable developing fetuses and preterm newborns. Ultimately a chain of basic newborn care, combined with special basic care for preterm newborns (thermal care, adequate feeding, hygiene, and counseling) is essential for more sophisticated clinical interventions and products to be successful in saving lives and limiting morbidity. Doing basic care well, for all pregnant women and newborns, will go a long way in supporting preterm survival and the effectiveness of clinical interventions directed at preterm complications. The numbers support this approach. Infants born before 34 weeks gestation, for which more advanced clinical interventions target, comprise roughly 3 percent of all births and about 30 percent of all preterm births. Also, the majority of newborns who die as a result of intrapartum complications, birth asphyxia, and severe newborn infection (also among the leading causes on newborn mortality) are preterm. Success depends on the right care, in the right place, at the right time—every time.

Photo: PATH/Eric Becker A new study suggests that the use of anti-parasitic drugs and insecticides in cattle can reduce human cases of Trypanosomiasis (sleeping sickness) by as much as 90 percent. Sleeping sickness is caused by parasites and transmitted by tsetse flies, and while cattle are not susceptible to human sleeping sickness, they do carry the parasite. The study, conducted in rural Uganda, involved injecting 500,000 cattle with two anti-parasitic drugs and spraying their legs, which the tsetse flies bite, with an insecticide. The team estimates that the program saved US$15 to $60 million in health care costs and increased Uganda’s gross national product by $400 million. Researchers at the Washington University School of Medicine in St. Louis have identified antibodies—immune system proteins—that could protect against or treat multiple alphaviruses, including Chikungunya. The antibodies are known as “broadly neutralizing antibodies,” a term which normally refers to antibodies that target different strains of the same virus (i.e., HIV, Hepatitis C) rather than different viruses altogether. The team, led by Dr. Michael Diamond, director of the Division of Infectious Diseases and Vaccine Development at Washington University School of Medicine, evaluated 60 human and mouse antibodies for Chikungunya and identified 10 that are active against three or more alphaviruses. The two most potent antibodies were then used as a treatment for mice infected with Chikungunya as well as two other alphaviruses—O’nyong’nyong and Mayaro virus—and the team confirmed that the antibodies reduced the symptoms of the infections. The team is using their findings to develop more antibodies which will then be tested on animals. New research conducted by professors Drs. Bruce Freedman and Ron Harty of the University of Pennsylvania School of Veterinary Medicine could pave the way for treatments against Ebola, among other viruses. Viruses utilize their hosts’ cells to mature, reproduce, and spread and Freedman and Harty have developed a mutated gene that blocks the pathways that many viruses use to communicate. By blocking those pathways, the virus remains trapped, unable to leave the cell and infect other cells. The team will next test their approach in mice with the ultimate goal of developing an anti-viral medicine effective against any virus that uses those same pathways to communicate.

The Global Health Technologies Coalition (GHTC) is excited to announce that Global Health Council (GHC) has joined the coalition. GHC is the leading membership organization supporting and connecting advocates, implementers, and stakeholders around global health priorities worldwide. “At Global Health Council, we seek to be the collaborative voice of the global health community and engage with key decision-makers to improve health globally through increased investment and policies,” said Dr. Christine Sow, president and executive director of GHC. “We recognize that research and development for new health technologies is an important part of the equation for delivering improved health worldwide and look forward to collaborating with GHTC and its members to drive forward policy solutions and investments that help catalyze the development of urgently needed health technologies.” Founded in 1972 as the National Council of International Health, the Council sought to bring together global health practitioners, researchers, and organizations to collaborate and share information with the collective goal of improving health worldwide. In 1998, the organization changed its name to Global Health Council to better reflect the scope of its work and global membership. Today GHC is comprised of over 70 member organizations—including nongovernmental organizations, foundations, corporations, faith-based organizations, and academic institutions—operating in more than 150 countries, and hundreds of individual members. GHC regularly convenes stakeholders around key global health issues and actively engages key decision-makers to influence health policy. “GHC has a long and distinguished history of bringing together diverse actors in the global health community to debate and collaborate around shared priorities and concerns in global health and is respected by policymakers for its leadership in the community,” said Erin Will Morton, GHTC’s coalition director. “We look forward to forging deeper relationships among both of our memberships as we work to advance the diverse set of solutions required to improve health worldwide.” For more information about Global Health Council, visit www.globalhealth.org.

Photo: CDC/ Dr. Mae Melvin A recently released clinical report from the US Centers for Disease Control and Prevention details a case of a Colombian man who developed cancerous tumors on his lungs and liver that were comprised of tapeworm cells, rather than human cells. An estimated 75 million people are infected by Hymenolepis nana, the most common human tapeworm, however, this is the first reported case of cancer spreading across species to humans. The team suspects that the tapeworm vector did not have cancer, but rather that one of its eggs mutated within the patient’s gut into cancerous cells. International Partnership for Microbicides (IPM), a member of the GHTC, is conducting Phase I clinical trials of a novel HIV and AIDS prevention method known as DS003. The drug binds to a protein on the surface of the HIV virus, preventing it from entering human immune cells. The trial will involve three stages, during which nine women will receive the drug and three will receive a placebo, enrolling 36 volunteers in total. At each stage, the participants will receive increasingly higher doses, from 1 to 10 mg, assuming that the previous stage demonstrated the drug to be safe and tolerable. The drug will be tested as a vaginal tablet, and if successful, DS003 will likely be tested in vaginal rings and/or in combination with other antiretroviral drugs. The fastest and most accurate tuberculosis (TB) diagnostic test will soon be available as a portable and more affordable device, making it more accessible in low-resource settings. Cepheid Inc.’s GeneXpert was endorsed by the World Health Organization in 2010, and its use increases the accuracy of diagnosis by 39 percent, however, the machine costs US$17,000 and requires electricity, refrigeration, and access to a computer. The new GeneXpert Omni will be rolled out early next year at a fraction of the cost—$2,895 for the machine and $10 per cartridge. The Omni runs on a battery and connects to a smartphone, weighs just 2.2 pounds, and can diagnose drug-resistant TB along with 23 other diseases.