ACT for Birth, Uganda (A=audit, C=cell phones, T=technology and training)

Each year millions of births, including those in facilities, occur without effective monitoring or appropriate response. The baby's heart rate is the most important signal of distress in labor. Inadequate heart rate monitoring and failure to respond to distress is an important determinant of almost 1 million newborn deaths and 1.2 million stillbirths each year globally.

Effective monitoring during labor in challenging settings depends on rugged, reliable, simple devices able to be used without electricity or batteries. This proposal involves testing an innovative fetal heart rate monitor powered by human energy (winner of the global INDEX design award) and mobile phone based mortality audit data to improve timely and appropriate action.

Uganda's new national paper-based mortality audit system will be adapted to a mobile phone platform to capture maternal and neonatal deaths and stillbirths, and use this data to improve intrapartum monitoring and response. Facilities will collect this data and will be linked to communities using cell phones to request emergency transport and report births and deaths.

A two-year seed grant is requested to develop and test in one district in Uganda the combination of novel technology (robust, human-powered fetal heart rate monitor) and quality improvement (cell phone-enabled mortality audit for maternal and neonatal deaths and stillbirths in facilities linking in communities). Both of these innovations have recently been listed within the top ten evidence gaps according to the Child Health and Nutrition Research Initiative and WHO.