A novel contraceptive makes life easier in Uganda and beyond

Woman on bench in empty clinic space.

A woman waits for health care at a clinic in Uganda’s Mubende District. Photo: PATH/Will Boase.

If you had to walk 14 miles and cross a river to get contraception, you might think twice about how to use your time.

Do I really need family planning? What are my chances of actually getting pregnant anytime soon? And will it be a long wait at the clinic?

Add children to the equation. Children who need your attention, now. And the meals that need to be made. After a while, the long walk gets pushed into the background as your day-to-day priorities take over.

So let’s change the equation

What if contraception could be accessed in your village in a simple dose that only required minimal training to administer? And as a bonus, the needle was smaller than the usual shot in the arm.

All of a sudden, making time gets a whole lot easier.

Woman looks on as Sayana Press shot is prepared.

Sayana Press brings long-acting injectable contraception closer to where many Ugandan women live. Photo: PATH/Will Boase.

A breakthrough for women

Fiona Walugembe.

Fiona Walugembe, PATH’s Sayana Press project coordinator in Uganda. Photo: PATH.

In the PATH office in Kampala, project coordinator Fiona Walugembe works closely with the ministry of health and country partners to implement a project designed to bring family planning choices closer to where women live.

Fiona coordinates Uganda’s pilot introduction of the long-acting, reversible contraceptive called Sayana® Press, a new formulation and presentation of the widely used Depo-Provera®. Sayana Press eliminates the need to prepare a needle and syringe. Instead, the contraceptive is delivered through the single-use Uniject™ injection system (originally developed by PATH). It’s a streamlined design that makes it easier for trained community health workers to safely provide injections in clinics, community locations, or villages.

Due to its design, Sayana Press presents an ideal opportunity to strengthen the capacity and expand the role of community-based health workers called Village Health Teams (VHTs) throughout Uganda.

“This is a breakthrough for women in Uganda. Sayana Press will go a long way in reaching out to women in the most remote areas, especially since injectables are already the most preferred method of family planning choice in Uganda. The fact that it is delivered in the all-in-one Uniject system with a shorter needle will be highly acceptable to the women,” says Fiona.

To date, the PATH team has trained about 260 VHTs in Uganda’s Mubende District, and Pathfinder Uganda has collaborated with PATH to train 100 more in Amuria District. PATH and Pathfinder are training these VHTs on a variety of family planning methods, including Sayana Press. Fiona has seen firsthand that the VHTs take this new opportunity and their responsibilities to their communities very seriously.

Hand holding Sayana Press single shot contraceptive.

A health worker holds a Sayana Press injectable contraceptive, which is being offered as a new family planning option in Uganda. Photo: PATH/Will Boase.

“Community health workers have welcomed this new option for women. They appreciate the ease of injection,” says Fiona. “One health worker in Uganda predicted that Sayana Press will expand access (to family planning) for busy young mothers who will now be able to visit a health worker in the community for an injection rather than waiting a long time at a clinic.”

Contraception that’s easy and inexpensive

Injectable contraceptives are a widely used family planning method for women, and have been used around the world for several decades. They are especially popular in developing countries, where the risk for maternal death during childbirth can be as high as 1 in 15. Each injection provides a woman with protection for roughly thirteen weeks (about three months). The downside is that, in many settings, the same woman must often travel to a clinic about every three months to receive each injection.

A woman holds her baby while receiving an injection.

A woman holds her baby while receiving the Sayana Press contraceptive. Photo: PATH/Will Boase.

However, Sayana Press may be more easily administered to women in remote, hard-to-reach areas by health workers like VHTs who have basic training—and potentially for women to administer themselves through self-injection. It’s contraception that’s easy to transport, easy to use, and designed to reach women wherever they live.

A health worker throws away a used injectable.

A health worker throws away a used Sayana Press injectable. Photo: PATH/Will Boase.

What lies ahead

This year Sayana Press was introduced in Uganda, Burkina Faso, and Niger, and Senegal is now following suit. PATH works closely with ministries of health (MOH) and local partners to coordinate these country-led introductions.

Since the program launched in Burkina Faso, approximately 75,000 Sayana Press units have been distributed to health facilities, and approximately 2,500 health care providers have been trained to administer Sayana Press. In Burkina Faso alone, preliminary data shows that more than 5,700 women are using Sayana Press, and over 1,600 of these women are new users of family planning. Data in Uganda are only just starting to come in, but a full report will be available early in 2015.

“By the end of the first quarter of 2015, PATH and Pathfinder together will have trained about 1,200 VHTs in 10 districts of Uganda,” says Fiona. “In the coming year or so, other partners in Uganda, including FHI 360, WellShare, and Marie Stopes Uganda, will train an additional 1,360 community health workers in 19 more districts. It is energizing to see these partners working collaboratively to increase contraceptive options for so many women in Uganda.”

PATH is starting to train VHTs in Gulu District, with a particular focus on ensuring young women can access Sayana Press. Youth-friendly, rights-based family planning is emphasized in all the VHT trainings throughout Uganda. In addition, in Gulu, PATH is supporting the Ugandan affiliate of International Planned Parenthood Federation, Reproductive Health Uganda (RHU), to integrate Sayana Press in their youth-friendly outreach and services.

In early 2015, PATH and the Ugandan MOH will also begin studies to explore how a self-injection program might work, including what support women would need to inject Sayana Press safely and effectively at home.

The potential for Sayana Press is becoming a reality—for the first time

The Bill & Melinda Gates Foundation, the Children’s Investment Fund Foundation (CIFF), and Pfizer just announced an agreement that will expand access to Sayana® Press even further, at a new per-dose price of US$1 to qualified purchasers such as procurement agencies like the United Nations Population Fund (UNFPA) or the United States Agency for International Development (USAID). The agreement will help ensure that women in the world’s 69 poorest countries have access to this new contraceptive option at reduced or no cost.

Tweet about Sayana Press NYT article from Melinda GatesThe consortium of public- and private-sector donors and aid organizations supporting this collaboration includes the United Kingdom’s Department for International Development (DfID), UNFPA, and USAID. These partners are playing an important role in ensuring that even more women can access Sayana Press. In addition to assisting with procurement, DFID, UNFPA, and USAID will support country introductions and the delivery of Sayana Press to health facilities.

“It is exciting,” said Fiona. “It is really a big thing.”

As access to Sayana Press increases due to the new product price, the pilot introductions are now even more important. PATH anticipates that this program will provide valuable information to more countries that choose to add Sayana Press to their family planning options under the new initiative. The lessons learned will help take this innovation to scale faster, offering millions more women access to family planning that meets their needs no matter where they live.

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Sayana® Press and Depo-Provera® are registered trademarks of Pfizer Inc. and/or its affiliates. Uniject is a trademark of BD.

Friday Think: you can bank on this breast milk app

Friday Think logoEach week, we scour the news for the hottest stories on innovation. Our weekly feature, The Friday Think, highlights one we’ve found particularly fascinating.

This week, we’re sharing a National Public Radio story about breast milk banks.

Each year, millions of children under the age of five die because as infants they lacked access to breast milk. Breast milk is better than formula for supporting a baby’s immune system and ability to thrive, especially if they’re premature or underweight. In countries with ample resources, access isn’t a problem, thanks to high-tech breast milk banks stocked by donors. The problem is greatest in rural, low-resource areas where 99 percent of infant deaths occur. And that’s because these places often lack or can’t afford expensive pasteurization technology.

What if there was a low-cost device that could safeguard donated milk so babies, whose mothers are unable to breast feed, could still get the nutrition they need?

Newborn in an incubator at a hospital.

A technology to pasteurize breast milk is helping those who are unable to breastfeed their babies. Photo: PATH/Wendy Stone.

Here’s an excerpt from NPR:

Now there’s a simple device called FoneAstra that, when combined with a smartphone, can pasteurize milk so a bank can be set up almost anywhere. The cost is only about $1,000.

But a commercial device to pasteurize breast milk can cost from $10,000 to $45,000—out of reach for rural clinics. …And that’s the part of the world where breast-milk banks are especially crucial. Each year, 800,000 children under the age of 5 die because they didn’t have access to breast milk—close to 1 out of every 8 infant deaths, most of which occur in developing regions.

Read the full story on the NPR website.

(Full disclosure: PATH and the University of Washington were instrumental in the development of this device and app.)

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What is “frugal science?” A visit to the home of the $1 folding paper microscope

Two men look at a hand-sized microscope made from folded paper in a lab.

PATH’s president and CEO Steve Davis and Dr. Manu Prakash discuss the $1 folding paper microscope developed in Prakash Lab at Stanford. Photo: PATH/Tom Furtwangler.

What innovations or economic opportunities would be unleashed if powerful microscopes only cost $1 each, and fit in a pocket?

What health improvements could result from bringing point-of-care diagnostics to the most remote outposts, in a simple wind-up device that does not need electricity or external chemical reagents?

Imagining—and then building—global health solutions at the visionary edge of possibility are part of the mission of Dr. Manu Prakash’s Stanford University bioengineering lab.

Their “frugal science” philosophy has already led to the development of the $1 folding paper microscope popularized by this TED talk, which has caught the imagination of more than 1.2 million viewers.

Two students talking in a lab full of devices.

Students are imagining—and then building—global health solutions at the visionary edge of possibility in Dr. Manu Prakash’s Stanford University bioengineering lab. Photo: PATH/Tom Furtwangler.

What does “frugal science” mean?

“Your lab thinks about many of the same problems we focus on at PATH, and in very similar ways,” said Steve Davis, PATH’s president and CEO, meeting with Manu and his students recently on campus at Stanford, where Steve is a visiting faculty member this quarter.

The students, a diverse group whose disciplines range from physics to mechanical engineering to music, and who represent countries from around the globe, work in a lab where frugal science is one of several areas of focus. Pressed by Steve to define the term, members of the group described how the frugal science concept frames their solutions-oriented work.

“Innovators in low-resource settings are really good at this,” said Elizabeth Marshman, a graduate student in the lab. “So it’s bringing that spirit of creativity to an environment like Stanford where there are so many people who are creative and capable and primed to innovate.”

Indian man and girl sit behind the wheel of a rickety truck.

This jugaad truck, like many in India, was built with a diesel engine originally intended to power an agricultural irrigation pump. Photo: Wikipedia.

“But it does not mean that you compromise, in terms of the solution,” added Manu.

“There is a word that gets tossed around, ‘jugaad,’ which happens to have Indian origins, and there are people in the management world who use jugaad as an analogy for problem-solving in business. By jugaad they really mean a hack, a quick way of getting to a one-time solution, but then you leave it there, and it’s often not sustainable or scalable or optimal in any way. Frugal science is not that.”

“Sometimes people are confused about this,” added graduate student Deepak Krishnamurthy, chiming in with enthusiasm. “But it’s about using cost as a parameter; it does not mean that you are going for a solution that is anything less than the optimal.”

Poster showing magnified images, with hand gesturing towards it.

Manu shows a poster describing how the pocket-sized microscope offers magnification over 2000X, at a cost under $1 per unit. Photo: PATH/Tom Furtwangler.

The impact of 10,000 free microscopes

While other lab innovations are moving from concept to prototype, the “Foldscope” origami microscope remains the lab’s most famous creation. For under $1, the microscope provides 2000X magnification, in a form that fits in a pocket or can be sent in the mail.

Recently the lab began distributing more than 10,000 of the devices for free, after collecting applications from more than 130 countries worldwide. “The only thing we asked in return is that they use a simple online form to submit how the microscope is being used,” said Manu.

As the submissions come in, user feedback shows the diverse and unexpected ways the Foldscope is being used, which was the whole point of sending out so many free kits.

A scrap metal recycler who earns a few dollars a day wrote that he can now tell more accurately which metal he is handling and whether he is getting a fair price for it. A beekeeper uses the Foldscope to diagnose parasites that are attacking her bees; healthier hives have the potential to increase her family’s financial security.

Three men hold and look at a small device in their hands.

Steve, Manu, and Kenyan graduate student George Korir discuss one of the lab’s innovative devices: a simple wind-up mechanism from a toy, reconfigured to run disease diagnostics using a paper strip carrying punch-card programming and embedded chemical reagents. Photo: PATH/Tom Furtwangler.

Bridging from the lab to the field

The lab’s intersection of cross-disciplinary experts who come together to solve complex problems mirrors the approach PATH often takes, a similarity noted by Steve in the discussion.

Promising to connect the lab’s students and projects with several PATH groups, he wrapped up the conversation with an encouragement to keep “moving development thinking to the left” as much as possible, explaining that he meant “taking considerations that often come much later in the product development process, like user testing, and manufacturing costs, and regulatory hurdles, and moving them to the left, meaning earlier, in the development cycle.”

“Your group’s emphasis on ‘frugal science’—a term that I love—is remarkable in its emphasis on integrating these cost and manufacturing considerations into your design thinking from the beginning,” said Steve.

Coverage plan: mobile phone app fights tuberculosis

Man and woman with their belongings at a local tuberculosis hospital.

It’s not uncommon for tuberculosis patients to experience long wait times at local hospitals in Vietnam. Photo: PATH/Nguyen Ba Quang.

What do the following facts have in common?

  • Vietnam has 90 million people and roughly 120 million mobile subscriptions (a 130 percent saturation rate).
  • Cases of multidrug-resistant tuberculosis are rising in Vietnam, 23 percent of which are retreatment cases.

Here’s the answer: The former is battling the latter in an innovative pilot program that’s shown promise in treating tuberculosis (TB). And a good portion of the work is literally in the hands of health workers and their patients.

Tuberculosis remains one of the world’s deadliest communicable diseases

The World Health Organization’s Global Tuberculosis Report 2014 affirms that globally, TB is the second-leading infectious disease, infecting over nine million people in the past year. Although Vietnam has achieved a high TB treatment success rate (over 90 percent), there’s still a great deal of work to be done.

PATH, working alongside the National TB Program, supports patients by helping them stick with their TB care plans through a project currently funded by The Global Fund for AIDS, Tuberculosis and Malaria. The objective? To improve adherence of TB care plans without further burdening public health resources.

Patients on cots at TB hospital.

PATH hopes to improve patient care and reduce the administrative costs associated with tuberculosis. Photo: PATH/Nguyen Ba Quang.

A novel coverage plan

Patients who do not closely follow their TB care plans are less likely to be cured or complete their full course of treatment. As a result of this behavior, the treatment success rate can drop and the multidrug-resistant tuberculosis (MDR-TB) rate can rise.

PATH’s TB team capitalized on the high level of mobile phone coverage in Vietnam by implementing a pilot mobile health application (mHealth app) that could access patient phone records through the national TB treatment management database. The app uses this information to send text messages (SMS) to patients, reminding them to take their medication and to show up for scheduled health checks and follow-up tests.

Commune health worker uses mobile phone application to enter data.

Commune health worker uses the mobile phone application to enter and upload TB patient information to the system. Photo: PATH/Dao Dinh Sang.

The application aims to support TB patient treatment adherence, which is especially important in a country where MDR-TB in both new and relapse TB cases is on the rise.

Two women sit in a waiting room

Two women sit in a TB hospital waiting room in Vietnam. Photo: PATH/Nguyen Ba Quang.

Piloted in 17 communes of Vung Tau City in Vietnam, preliminary findings show that the app increased the percentage of on-time visits for scheduled health checks (from 72.3 to 82 percent for the third visit), as well as overall treatment success rates (from 91 to 98 percent) in TB patients. PATH’s app allows TB patients to better manage their treatment, empowering them to take control over the disease. One of the most exciting aspects of this app is that Vung Tau City has expanded its use within the province post-pilot, which shows great promise for the cost-effectiveness and sustainability of this tool.

Incorporating mHealth solutions is new territory for tuberculosis efforts in Vietnam, but based on the positive results so far, the team is looking to expand the reach of this app and other potential mHealth solutions. An evaluation of the pilot, planned for mid-2015, will contribute to a set of recommendations for the National TB Program.

The team’s success with the pilot mHealth app was accepted for oral presentation at the 45th Annual TB Union Conference in Barcelona, Spain.

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Guest contributor Claire Topalian is a freelance writer for PATH.

Friday Think: the $150 Ebola technology challenge

Friday Think logo

Each week, our media team scours the news for the hottest stories on innovation and shares them with us. Our weekly feature, The Friday Think, highlights one story we’ve found particularly fascinating.

This week, we’ll focus on Dr. Ian Lipkin, a professor at Columbia and one of the world’s leading infectious diseases investigators. Lipkin appeared on the radio program Here & Now (NPR and WBUR Boston) after he challenged college students at Columbia’s School of Engineering and Applied Science to come up with low-cost technology solutions($150 or less) to problems encountered during Ebola treatment. Oh, and he wanted these solutions within two weeks’ time.

Never underestimate the ingenuity of thrifty college students

Dr. Lipkin received submissions as varied as using a colored bleach foam so health workers could see if sanitation measures were effective, to hazmat suits outfitted for long work days with hydration systems. Here’s the story:

Listen to the story on the WBUR website.

The future of field-appropriate diagnostics

Adolescent holding an infant.

Eliminating neglected tropical diseases are the focus of diagnostic tools and innovations. Photo: PATH/Gabe Bienczycki.

Editor’s note: This week PATH is announcing the launch of a new diagnostic test for river blindness with manufacturing partner Standard Diagnostics, Inc. This is the third day of a blog series exploring how river blindness affects communities, how the diagnostic test works, and why diagnostic tools are the next wave in global health innovation.

Part 3: The future is quick, nimble, and surprisingly simple

Yesterday we talked about a new diagnostic test for river blindness, one of 17 neglected tropical diseases (NTDs) the World Health Organization (WHO) has targeted for control, elimination, or eradication by 2020. The new rapid test is a bold first step by PATH to support reaching these targets.

Children play in the river.

Women and children from a community in Togo exposed to river blindness gather at the shore during a 2013 PATH field study of the SD BIOLINE Onchocerciasis IgG4 rapid test prototype. Photo: PATH/Dunia Faulx.

“What’s needed now is quick action to add this simple test to control and elimination programs.” said David C. Kaslow, vice president for Product Development at PATH.

Over the next several years, PATH will leverage its expertise, innovation, and global partnerships to speed the development of a suite of diagnostic tools to help eliminate other NTDs. Together, these collaborative efforts will reduce suffering, improve health equity, and help communities thrive worldwide.

“The lack of sensitive, effective, and field-ready diagnostic tests for NTDs is a critical gap in the global health community’s ability to direct control and elimination efforts and track progress in the fight against NTDs,” says Tala de los Santos, group leader of Diagnostics at PATH.

A battle against the scourges

Neglected tropical diseases are a set of infectious diseases that affect more than one billion people worldwide, mainly in sub-Saharan Africa, Asia, and Central and South America. They cause significant illness, disability, pain, and suffering, and their effects are especially hard on women and children. Women often have to care for sick family members, limiting their opportunities as well as making them vulnerable to infection; children are also at high risk of infection, and their physical and cognitive growth are negatively impacted by these diseases. The effects of NTDs on health and development contribute to keeping the world’s most vulnerable communities trapped in a cycle of illness and poverty.

Gloved hands applying a blood sample to a malaria diagnostic next to a test log and pill packet nearby.

A health worker applies a blood sample to a malaria diagnostic test as part of the Malaria Control and Evaluation Partnership in Lusaka, Zambia. Photo: PATH/Gena Morgan.

It’s not all about the apps; they must be appropriate tools

Diagnostic tools play a crucial role in the entire surveillance process. Their impact can be felt from initial mapping of an endemic area to confirming elimination. And in many cases, confirming an area has eliminated a disease can be challenging.

Anurag Mairal, Technology Solutions leader at PATH, agrees: “Vaccines and drugs typically take priority in the fight against neglected diseases. But without diagnostics, it’s hard to know whether a program is having an impact.”

Add to the fact that many current diagnostic tests require a person travel to a clinic, often miles away from their rural community, before they can receive the correct treatment. It’s just one more argument for the development of field-based tests that are rapid, simple, and accurate.

Additional resources will be needed to ensure that tests are produced and made available to national NTD control and elimination programs. Once these are applied in the field, the new tests can help to guide policy and further political and financial support for NTD programs. To that end, PATH will work with partners to identify opportunities to bring these products to market.

At PATH, we call these opportunities to improve the health and livelihoods of people game-changing technologies. And we believe the outcomes result in an extraordinary return on investment.

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New test combats major cause of preventable blindness in Africa

Woman standing outside next to a table where two health workers complete paperwork.

Local health workers register a community member for a river blindness test during a PATH visit to Morogoro, Tanzania. Photo: PATH.

Editor’s note: This week PATH is announcing the launch of a new diagnostic test for river blindness with manufacturing partner Standard Diagnostics, Inc. This is the second day of a blog series: yesterday we explored how river blindness affects communities, today we look at how the diagnostic test works, and tomorrow we’ll cover why diagnostic tools are the next wave in global health innovation.

Part 2: A faster, easy-to-use test to help stamp out a neglected tropical disease

As we described yesterday, onchocerciasis, commonly known as river blindness, is caused by a parasitic worm transmitted to humans through the bite of the blackfly. It causes itching, skin disfiguration, and, with chronic exposure, permanent blindness. Globally, an estimated 120 million people are at risk for river blindness, and 18 million are infected. The disease typically affects poor, rural communities who live near streams and rivers. In the past, entire communities fled their homes to avoid contracting the disease, leaving valuable farmland behind and putting their livelihood at risk.

Elimination in reach

Effective and widespread treatment, control, and surveillance, together with the efforts of international and local community leaders, have put the global elimination of river blindness within reach. In the past two years, the World Health Organization (WHO) has declared two countries in the Americas, Colombia and Ecuador, free of the disease. Achieving the same elimination goals in African countries requires better diagnostic tools. The easy-to-use new rapid test meets this need by supporting fast, effective, and community-wide testing to identify areas where the disease is still active, guide the allocation of limited resources, prevent the disease from reemerging, and confirm elimination. By streamlining testing, it can help expand surveillance activities and accelerate global efforts to stop river blindness for good.

A health worker takes a drop of blood from the finger of a person.

A health worker takes a drop of blood from the finger of a person in Togo during a 2014 PATH field study of the SD BIOLINE Onchocerciasis IgG4 rapid test for river blindness. Photo: PATH/Dunia Faulx.

“The proven technology behind this test makes it a powerful and reliable tool in the multinational collaboration to eliminate river blindness,” said David C. Kaslow, vice president for Product Development at PATH. “The availability of a rapid, point-of-care diagnostic is a harbinger of a world free of the suffering caused by this insidious parasite. What’s needed now is quick action to add this simple test to control and elimination programs.”

An appropriate tool

The new onchocerciasis test is specifically tailored for use in the remote, low-resource settings where it is needed most. It offers a breakthrough alternative to the existing test, which involves an often painful procedure to remove a small portion of skin for examination under a microscope. When faced with this prospect, some communities avoid participating in surveillance testing altogether.

Stamping out NTDs

River blindness and other NTDs exact a devastating toll on vulnerable communities in sub-Saharan Africa, Asia, and Central and South America. Through illness, disability, pain, and suffering, they damage health and economic development and perpetuate cycles of poverty and inequity. Recognizing this threat, the WHO has targeted 17 NTDs, including river blindness, for control, elimination, or eradication by 2020. Developing new diagnostics is one key priority.

Gloved hands hold a prototype of the new SD BIOLINE Onchocerciasis IgG4 rapid test.

A health worker holds a final prototype of the new SD BIOLINE Onchocerciasis IgG4 rapid test, manufactured by Standard Diagnostics, Inc. The test has a line at “C” indicating it is working properly, and no line at “T” indicating a negative test result (the test detected no antibodies to river blindness in the blood sample). Photo: PATH/Dunia Faulx.

The new rapid test is a bold first step for PATH in support of this priority. Over the next several years, PATH will leverage our expertise, innovation, and global partnerships to speed the development of a suite of diagnostic tools to help eliminate several other NTDs. Together, these collaborative efforts will reduce suffering, improve health equity, and help communities thrive.

Illustration of the onchocerciasis rapid test, including air openings, test result windown, blood sample port, and buffer port.

The rapid test has been designed for use in low-resource settings by health workers in the field. Illustration: PATH.

Tomorrow we’ll look at the future of diagnostic tools and the importance they serve in global health innovation.

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The flies have it: river blindness and the communities it affects

Group of people beside river.

Rivers are a water source near many homes in Africa. They’re also home to the blackfly and a parasite they carry that causes river blindness. Photo: PATH/David Jacobs.

Editor’s note: This week PATH is announcing the launch of a new diagnostic test for river blindness with manufacturing partner Standard Diagnostics, Inc. Over three days, our blog series will explore how river blindness affects communities, how the diagnostic test works, and why diagnostic tools are the next wave in global health innovation.

Part 1: The water: a gift and a curse

Let’s say you’re a farmer. What’s the best resource you could hope for next to your land? Water. Right?

Let’s take it deeper: as a farmer, you’d prefer a river, a rapidly flowing water source with no stagnation. Flowing water helps flush impurities downstream, provides fish to eat, and limits breeding opportunities for the mosquito, an insect that can spread illnesses such as malaria and encephalitis. Yes, a river would be ideal. Which is why communities have settled by rivers for thousands of years.

So why is it that having a fast-flowing river near an agricultural area may cause people to abandon productive fields? If you’re thinking floods, think again.

It’s the flies.

A blackfly magnified at 100X actual size.

Adult blackfly magnified 100X using conventional scanning electron microscopy with parasite (Onchocerca volvulus) emerging from the insect’s antenna. The parasite is responsible for the disease known as river blindness. Photo: US Department of Agriculture.

Meet the culprit

Flies do more than pester people—they can spread disease.

Across wide swaths of Africa, one such nasty illness is a parasitic infection called “river blindness” (onchocerciasis). The parasite is found in more than 100,000 communities in 31 African countries, 6 Latin American countries, and Yemen. Estimates of the number of people affected are mind-boggling: 120 million people remain at risk for the disease and 18 million people are infected, typically in poor, rural communities in remote low-resource settings.

The blackfly breeds in the fast-flowing waters of rivers. It’s generally a harmless insect, unless it’s carrying the river blindness parasite. When a fly with the parasite bites a human, it passes along the microscopic parasitic worm which multiplies under the skin of their hosts, causing their skin to become painfully itchy. Without treatment, this condition can become chronic. Eventually the worms can migrate to the cornea of the eyes resulting in scarring and permanent blindness.

This Carter Center video takes you to the Nebbi District in Uganda, where one family has suffered the devastating effects of river blindness. Video length: 3:08 minutes.

And so the lifecycle continues, resulting in blindness among affected people and transmission of the parasite to others.

The lifecycle of river blindness: bite from parasitized blackfly, infection by larvae under the skin, reproduction of worms, proliferation of microfilariae, and transport of microfilariae to the cornea.

This infographic details the lifecycle of river blindness. Illustration: PATH.

Before you think all is lost

There is a medicine called ivermectin that paralyzes and kills the offspring of adult worms in humans, halting their lifecycle. And for nearly 20 years, the African Program for Onchocerciasis Control has helped map transmission zones and treat communities by mobilizing local agencies and networks to identify the disease’s prevalence. Then it’s usually local volunteers who give out the medicine and keep track of who has been treated.

However, it’s hard to know when to stop treating communities with ivermectin. When successful, ivermectin breaks the transmission of river blindness so fewer and fewer people are exposed over years of treatment. But current tests to see if a person has antibodies to the parasite (a sign they’ve been exposed to the disease) often require sending blood samples to a lab, waiting weeks for evaluation by a highly trained technician, and using expensive equipment. And the most common test to see if a person has an active infection is an invasive skin snip. This is a painful test that provides results within 24 hours but exposes people to infection. Because of these challenges testing has been difficult to administer, especially among families with children.

Programs are committed to treating entire communities until they’re sure the disease is gone, and there’s no doubt that this reduces the suffering caused by river blindness. But until they can confirm that transmission has been irreversibly stopped, the overarching problem remains: the disease cannot be eliminated if it risks being reintroduced.

A man watches cows in the river.

A man watching cattle drink from the river. Photo: PATH/Jesse Schubert.

To speed elimination efforts, these programs need a new diagnostic tool that’s less invasive and provides faster results in the field. A test that is easier to use and less expensive. One that won’t dissuade people from being tested.

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Tomorrow: a new, innovative point-of-care test.

Your innovation story for the weekend

Friday Think logoEach week, Claire Hudson, PATH’s media relations extraordinaire, casts her net to look for the week’s hottest stories on innovation to share with everyone at PATH. It’s a thoughtful collection, a little outside the box, and not necessarily focused on global health. It’s always an excellent weekend read.

This got us thinking: Why not share one of these stories with all of you? We’ll call it The Friday Think. Sometimes we’ll tell you what we think is innovative about the weekly pick. Sometimes we’ll let the story speak for itself.

This week, in light of All Hallow’s Eve, a wide range of stories presented themselves, from frightening images of magnified parasites to creative app-driven costumes.

Man hanging from balloon. Photo: J. Martin Harris Photography/Paragon Space Development Corporation.

Alan Eustace ascending to 135,890 feet above Earth.

But when push came to shove, we decided to share a couple of stories from The New York Times about Alan Eustace, a man who took a balloon ride to the edge of space and then fell back to Earth 130,000 ft (a mere 25 miles). Not only did his balloon require a whole lot of helium, but on the way back down, Alan broke the sound barrier before opening his parachute.

“It was amazing,” he said. “It was beautiful. You could see the darkness of space and you could see the layers of atmosphere, which I had never seen before.”

Mr. Eustace cut himself loose from the balloon with the aid of a small explosive device and plummeted toward the earth at speeds that peaked at 822 miles per hour, setting off a small sonic boom heard by people on the ground.

The New York Times followed up later this week with a closer look at the engineering and technical challenges Alan Eustace faced before launch day. It’s worth noting, Alan’s an engineer by trade.

A veteran computer designer, Mr. Eustace approached the technical challenges of finding a new way to reach the edge of space and return safely—without power—with a methodical engineering strategy that has served him well in Silicon Valley.

Advocating better health for Zambia’s newborns

A mother and her child.Health advocates and government groups have made a pact to improve newborn and child health care in Zambia. Photo: PATH/

Health advocates and government groups have made a pact to improve newborn and child health care in Zambia. Photo: PATH.

Today, newborns in Zambia have a better chance for survival and a healthier future thanks, in part, to recent health policy actions that are actively supported by PATH and local health partners.

For nearly 20 years, Zambia has had one of the highest infant death rates in the world. While the country is on track to reduce deaths of children under the age of five (read more about the Millennium Development Goals), it has failed to make similar progress in reducing newborn deaths.

Government policies have been silent on newborn health, and government decision makers have rarely addressed the issue.

Three women holding babies on their laps.

Mothers and their children at a health clinic. Photo: PATH/Wendy Stone.

The lack of policies has “had a very negative bearing on getting resources allocated to newborn health activities,” says Vichael Silavwe, Zambia’s chief integrated management of childhood illnesses officer in the Ministry of Community Development, Mother and Child Health. He adds that without policies, government officials and health workers have not had the necessary support to improve infant health.

A new beginning for Zambia’s children

But the launch earlier this month of two new government health policies signals a major shift in the country’s priority of newborn health. On October 14, 2014, the Honorable Emerine Kabanshi, Minister of Community Development, Mother and Child Health, unveiled two national child health policies: a set of Essential Newborn Care guidelines and the National Integrated Management of Child Illness strategic plan.

Together, these policies provide gold standard guidance for health workers who care for newborns, and they create a foundation for key decision-makers to allocate additional staff and budgets to newborn health services.

Silavwe says the policies are significant because they promise to improve stakeholder coordination for health programs at both the community and national levels.

“This is a great opportunity,” he adds, “to bridge the gap between national policy and local district action to raise coverage of essential interventions, mobilize resources, and measure progress towards reducing infant and newborn deaths.”

Celebrating years of work

This is the successful culmination of years of behind-the-scenes work by newborn health advocates dedicated to making newborn health a political priority.

Three years ago, newborn health advocates in Zambia—including PATH, Save the Children, the Ministry of Health, Zambia Pediatrics Association, the World Health Organization, and UNICEF—created a coalition to secure a newborn health policy framework to increase funding for newborn health, improve health worker training, integrate newborn care with other child health services, and raise political visibility. With these mandates in place, they believed doors would open for new treatments, technologies, and better newborn care by doctors and nurses.

Dr. Nanthalile Mugala, PATH’s country manager for Zambia, says, “This process demonstrates the power of policy advocacy. Through partnerships and close coordination, we support the Zambian government in developing policies that provide for the rapid scale-up of newborn health care in the country.”

Moving forward to save newborn lives

Now that newborn health policies have been created and launched in Zambia, what comes next?

Advocates will continue working with government partners to ensure these policies are implemented in communities.

Government officials must ensure political will remains high and budgets are allocated towards lifesaving interventions and programming.

Health workers and medical professionals will have opportunities for better training in new practices.

Most importantly, babies in Zambia will have the chance for a brighter future.

More information