The CRADLE vital signs alert: qualitative evaluation of a novel device designed for use in pregnancy by healthcare workers in low-resource settings

ObjectivesHaemorrhage, hypertension, sepsis and abortion complications (often from haemorrhage or sepsis) contribute to 60% of all maternal deaths. Each is associated with vital signs (blood pressure (BP) and pulse) abnormalities, and the majority of deaths are preventable through simple and timely intervention. This paper presents the development and evaluation of the CRADLE Vital Signs Alert (VSA), an accurate, low-cost and easy-to-use device measuring BP and pulse with an integrated traffic light early warning system. The VSA was designed to be used by all cadres of healthcare providers for pregnant women in low-resource settings with the aim to prevent avoidable maternal mortality and morbidity.MethodsThe development and the mixed-methods clinical evaluation of the VSA are described.ResultsPreliminary fieldwork identified that introduction of BP devices to rural clinics improved antenatal surveillance of BP in pregnant women. The aesthetics of the integrated traffic light system were developed through iterative qualitative evaluation. The traffic lights trigger according to evidence-based vital sign thresholds in hypertension and haemodynamic compromise from haemorrhage and sepsis. The VSA can be reliably used as an auscultatory device, as well as its primary semiautomated function, and is suitable as a self-monitor used by pregnant women.ConclusionThe VSA is an accurate device incorporating an evidence-based traffic light early warning system. It is designed to ensure suitability for healthcare providers with limited training and may improve care for women in pregnancy, childbirth and in the postnatal period.

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A Low Cost Wearable Medical Device for Vital Signs Monitoring in Low-Resource Settings

International Journal of Electrical and Computer Engineering (IJECE) ◽

10.11591/ijece.v9i4.pp2321-2327 ◽

2019 ◽

Vol 9 (4) ◽

pp. 2321

Author(s):

Muhammad Niswar ◽

Muhammad Nur ◽

Idar Mappangara

Keyword(s):

Heart Rate ◽

Respiratory Rate ◽

Medical Device ◽

Low Cost ◽

Vital Signs ◽

Oxygen Saturation Level ◽

Low Resource Settings ◽

Low Resource ◽

Vital Signs Monitoring ◽

Wearable Medical

Medical devices are often expensive, so people in low-income countries cannot afford them. This paper presents the design of a low-cost wearable medical device to measure vital signs of a patient including heart rate, blood oxygen saturation level (SpO2) and respiratory rate. The wearable medical device mainly consists of a microcontroller and two biomedical sensors including airflow thermal sensor to measure respiratory rate and pulse oximeter sensor to measure SpO2 and heart rate. We can monitor the vital signs from a smartphone using a web browser through IEEE802.11 wireless connectivity to the wearable medical device. Furthermore, the wearable medical device requires simple management to operate; hence, it can be easily used. Performance evaluation results show that the designed wearable medical device works as good as a standard SpO2 device and it can measure the respiratory rate properly. The designed wearable medical device is inexpensive and appropriate for low-resource settings. Moreover, as its components are commonly available in the market, it easy to assembly and repair locally.

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Comprehensive pregnancy monitoring with a network of wireless, soft, and flexible sensors in high- and low-resource health settings

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2100466118 ◽

2021 ◽

Vol 118 (20) ◽

pp. e2100466118

Author(s):

Dennis Ryu ◽

Dong Hyun Kim ◽

Joan T. Price ◽

Jong Yoon Lee ◽

Ha Uk Chung ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Body Position ◽

Vital Signs ◽

Blood Oxygenation ◽

Morbidity And Mortality ◽

Low Resource Settings ◽

Low Resource ◽

Vital Signs Monitoring ◽

Wide Range

Vital signs monitoring is a fundamental component of ensuring the health and safety of women and newborns during pregnancy, labor, and childbirth. This monitoring is often the first step in early detection of pregnancy abnormalities, providing an opportunity for prompt, effective intervention to prevent maternal and neonatal morbidity and mortality. Contemporary pregnancy monitoring systems require numerous devices wired to large base units; at least five separate devices with distinct user interfaces are commonly used to detect uterine contractility, maternal blood oxygenation, temperature, heart rate, blood pressure, and fetal heart rate. Current monitoring technologies are expensive and complex with implementation challenges in low-resource settings where maternal morbidity and mortality is the greatest. We present an integrated monitoring platform leveraging advanced flexible electronics, wireless connectivity, and compatibility with a wide range of low-cost mobile devices. Three flexible, soft, and low-profile sensors offer comprehensive vital signs monitoring for both women and fetuses with time-synchronized operation, including advanced parameters such as continuous cuffless blood pressure, electrohysterography-derived uterine monitoring, and automated body position classification. Successful field trials of pregnant women between 25 and 41 wk of gestation in both high-resource settings (n = 91) and low-resource settings (n = 485) demonstrate the system’s performance, usability, and safety.

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Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.00040 ◽

2020 ◽

Vol 7 ◽

Author(s):

Shobhana Nagraj ◽

Stephen H. Kennedy ◽

Robyn Norton ◽

Vivekananda Jha ◽

Devarsetty Praveen ◽

...

Keyword(s):

Risk Factors ◽

Cardiometabolic Risk ◽

Research Priorities ◽

Cardiometabolic Risk Factors ◽

Low Resource Settings ◽

Low Resource ◽

In Pregnancy

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Perspective: L-arginine and L-citrulline Supplementation in Pregnancy: A Potential Strategy to Improve Birth Outcomes in Low-Resource Settings

Advances in Nutrition ◽

10.1093/advances/nmz015 ◽

2019 ◽

Vol 10 (5) ◽

pp. 765-777 ◽

Cited By ~ 4

Author(s):

Andrea M Weckman ◽

Chloe R McDonald ◽

Jo-Anna B Baxter ◽

Wafaie W Fawzi ◽

Andrea L Conroy ◽

...

Keyword(s):

Nitric Oxide ◽

Birth Weight ◽

Preterm Birth ◽

Birth Outcomes ◽

Fetal Growth ◽

Adverse Birth Outcomes ◽

Low Resource Settings ◽

Low Resource ◽

Arginine Supplementation ◽

In Pregnancy

ABSTRACT The available data support the hypothesis that L-arginine or L-citrulline supplementation would be suitable for implementation in resource-constrained settings and will enhance placental vascular development and improve birth outcomes. In resource-constrained settings, the rates of adverse birth outcomes, including fetal growth restriction, preterm birth, and low birth weight, are disproportionately high. Complications resulting from preterm birth are now the leading cause of mortality in children <5 y of age worldwide. Despite the global health burden of adverse birth outcomes, few effective interventions are currently available and new strategies are urgently needed, especially for low-resource settings. L-arginine is a nutritionally essential amino acid in pregnancy and an immediate precursor of nitric oxide. During pregnancy, placental and embryonic growth increases the demand for L-arginine, which can exceed endogenous synthesis of L-arginine from L-citrulline, necessitating increased dietary intake. In many low-resource settings, dietary intake of L-arginine in pregnancy is inadequate owing to widespread protein malnutrition and depletion of endogenous L-arginine due to maternal infections, in particular malaria. Here we examine the role of the L-arginine–nitric oxide biosynthetic pathway in pregnancy including placental vascular development and fetal growth. We review the evidence for the relations between altered L-arginine bioavailability and pregnancy outcomes, and strategies for arginine supplementation in pregnancy. Existing studies of L-arginine supplementation in pregnancy in high-resource settings have shown improved maternal and fetal hemodynamics, prevention of pre-eclampsia, and improved birth outcomes including higher birth weight and longer gestation. Arginine supplementation studies now need to be extended to pregnant women in low-resource settings, especially those at risk of malaria.

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