Sanghvi_Screening and Early Detection of PEE

8/2/2019 Sanghvi_Screening and Early Detection of PEE

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Screening and Early Detection ofPreeclampsia

Harshad Sanghvi

Vice-President Innovations, Medical Director

Asia Region Meeting: Making every mother and baby count

Dhaka, May 2012


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Definitions

Preeclampsia: Hypertension, proteinuria inpregnancy

Mild: Diastolic 90-100, proteinuria1-2g/l

Severe: diastolic 110+, proteinuria 3g/l Eclampsia: +convulsions

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Preeclampsia: The Knowledge

Preeclampsia is the second biggest

killer of women and babies

All preeclampsia is detectable by doing

a blood pressure and protein test

periodically in pregnancy We have had that evidence for 50+

years

More than 50% of women worldwide do

not get a minimum of 4 ANC visits

Much more than 50% of women do not

get both a BP test and protein test

If we do not detect preeclampsia, we

will eventually find out when women get

Eclampsia

Maternal Mortality Map of the World


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Understanding

To eliminate preventable eclampsia, we need to detect allthe preeclampsia that there is and so we need to do a BPand protein test periodically in women whether they can

come to clinics or notNo amount of improvement in facility PEE detection willdetect all the PE.


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Prediction of Preeclampsia

Risk factors not very useful

No effective or affordable biochemical or

biophysical predictor available after exploringalmost 40 approaches

Implication: All pregnant women are potentially at riskneed prevention as well as early detection of PE


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Massive unmet need for early detection ofPE Source DHS

Country % Unmet need for BPCheck

% Unmet need forProteinuria Check

Bangladesh 53.1% 70.5%

Bolivia 24.5% 50.9%

DRC 38.8% 57.8%

India 52.5% 56.8%

Indonesia 13.9% 63.0%

Kenya 22.8% 38.9%

Malawi 28.6% 81.3%Mozambique 48.7% 73.9%

Nepal 43.8% 77.7%

Zimbabwe 14.0% 39.8%

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SBMR: Nepal Experience in improvingquality of PEE care

Intervention: 1 day on site whole facility orientation byNESOG

Review of standards, practice of skills

Baseline assessment, gap analysis, action plan

Re-assess at 2, 4 months

Lots of phone follow up

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Baseline 2months

4 months

% facilities meetingstandards

14% 36% 59%

% facilities whereno standard met

27% 0% 0%

Average score 26% 60% 63%

facility Reachedstandardin 6months

SBAtrainingsites

87%

MOHHosp

50%

Privatehospitals

17%

Medschool

38%

PHCC 33%


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Some issues with measuring BP

Significant training needed to do BP well

Equipment failure: The frequent marketing of non-validated blood pressure measuring

devices that do not work for long

The relatively high cost of blood pressure devices given the limitedresources available

Limited awareness of the problems associated with conventionalblood pressure measurement techniques;

Aneroid BP machines require frequent recalibration

about 45% of all machines tested in one study were off by15mm diastolic


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Specifications for a Hypertension detector forcommunity use

Functional Requirements

Utilizes systolic and diastolic BP

On-site calibration

Portable, low weightHuman Factors

Binary output

Culturally acceptable exterior,

suited for use by non literateproviders

Environmental Factors

Water /dust resistant

Shock resistant

Rechargeable energy source

And:

Low cost

Low complexity

Simple instructions Minimal moving parts

Long lasting ( 3 Years)

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Early prototypes


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Community Hypertension Detector

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Testing for proteinuria

Urine dipstick tests quite pricey: Test reagent is not what makes it pricy.

Difficult to void urine on the reagent area, so need collection in bottle

Much user variability in interpreting graded color change

Boiling not feasible in high-volume sites, not suitablefor home testing

Esbach takes 24 hours and is quite complex


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Specifications for a community urine protein test

Functional Requirements

As accurate as dipstick

Minimal steps required

Human Factors Binary output, easy to

interpret

Avoid urine collection in

bottle

Culturally appropriate

Environmental Factors

Robust

Stays accurate in harsh

environmental conditions

AND

Very low cost

Low complexity

Simple instructions

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Benjamin Yoo, Thembi Mdluli, Millie Shah,

Sean Monagle, Stephen Dria, Ezra Taylor,Elisa

No, Elaine Yang, Britni Crocker, Jackie Birkness

Peter Truskey, Maxim Budyansky, Sean

Monagle, James Waring, Matthew Means, Sherri

Hall, Mary OGrady, Shishira Nagesh

2010-11

Development Teams

2009-10

2010-11


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How can we detect all the Preeclampsiabefore it becomes life threatening

Take testing for hypertension and proteinuria to womenin their homes

Reagent modified to yield sharpcolor change when there is 0.3g/l

protein: The test strip prepared by

marking an end of a piece of filterpaper with the reagent.

Use: Pregnant woman who is

instructed to void urine on thetest area of the strip and report ifa color change from yellow toblue occurs.


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Screws, Bottle Caps

Righty Tighty, Lefty Loosey

Normal Threading Reverse Threading

Most people assume cap is

sealed and cant be opened

Frugal Engineering


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Validation of POC test in ANC Clients,Rural Nepal

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Compared to Esbach (>.30 vs.


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Documents

Sanghvi_Screening and Early Detection of PEE