June 1, 2020
In this series of articles, I address health challenges in Colombia and other Latin American countries. I highlight the potential adaptation of technologies, services, and policies to solve these public health issues such as maternal mortality and the vertical transmission of infections. Estimating the burden of these issues is necessary for determining priorities for future research and for health systems to take actions to reduce them.
Around 7,300 women lose their lives annually in Latin America and the Caribbean due to pregnancy-related causes (Unicef, Health Equity Report – 2016). The countries in the region with the highest maternal mortality are Haiti (480 per 100,000 births), Guyana (169), Bolivia (155), Paraguay (129), and Surinam (120). The ones with the least maternal deaths per 100,000 births are Chile (13), Uruguay (17), Barbados (27), Costa Rica (27) and Mexico (33). Whereas global estimates show that the countries that achieved the lowest maternal mortality rates are Finland, Greece, Iceland, and Poland, with 3 mothers dying every 100,000 births (WHO & Gender Equality Observatory – 2017).
Maternal mortality is a key indicator of health inequity
In Colombia, a country with 50 million people, around 500 annual maternal deaths are reported and the maternal mortality ratio in 2019 was of 47 deaths (per 100,000 births), considered a relatively low rate by the WHO. Yet, behind that national average there is a disparity between departments (or regions), with a ratio exceeding 100 deaths (per 100,000 births) in 7 states. The majority of events (60%) occur at an early stage (during pregnancy, childbirth and up to 42 days after the end of pregnancy), corresponding mainly to severe bleeding (during and after childbirth) (20%) and pregnancy-induced high blood pressure (20%) (INS- National Health Institute. 2019).
Vertically transmitted infections
Progress towards a generation free of AIDS and syphilis has been very significant in the Americas, as the efforts to ensure that children are born without hepatitis B and Chagas disease. However, it is necessary to expand access to health services to end the transmission of these four diseases.
Vertically transmitted infections are important public health problems since they can precipitate the suffering of a chronic condition with serious consequences with high social and economic costs for patients.
The PAHO report in 2019, with data collected from 52 countries and territories in the Americas, shows that the estimated mother-to-child transmission rate of HIV decreased from 17% in 2010 to 12% in 2017, representing an estimated 30,800 HIV infections in children averted due to prevention interventions, including an increase in HIV testing coverage in pregnant women and antiretroviral therapy in those women that test positive.
However, cases of congenital syphilis have been on the rise, in 2017, 37 countries reported more than 28,800 cases, 22% more than in 2016. In Colombia, the cases reported in 2019 exceeded the expected number with 1,302 cases of congenital syphilis and 7,249 of gestational syphilis. This is a significant number considering that syphilis can be prevented and also treated at a very low cost. Among the risk behaviours for the transmission of syphilis are beginning of sexual activity at an early age, high-risk sexual practices, and multiple sexual partners.
The countries of the Americas have vaccinated against hepatitis B for more than 20 years, which has facilitated the achievement of the goal of eliminating mother-child transmission of this disease in the region. On the other hand, it is estimated that each year about 9,000 babies are born with Chagas disease in the region, which represent more than 20% of all new cases. Showing the urgent need to improve detection, notification and monitoring systems.
Smart solutions help to expand access to health services
Access to high-quality and comprehensive sexual and reproductive health services, including family planning and contraceptive methods, as well as access to antenatal and delivery care play an important role in achieving the elimination of mother-to-child transmission of infectious diseases and the reduction of maternal mortality.
New approaches, such as artificial intelligence and smart technologies, could expand the access to health services, mitigating the current reproductive health needs in emerging countries. Yet, it is important to adapt them to the local needs, since they are being designed in a context of developed countries. Also, it is necessary to assess the perceptions among pregnant patients and health care providers in incorporating these novel technologies into their daily routine and clinical practice.
1) Contraceptive methods
The use of contraceptive methods reduces maternal mortality by 30%. It allows proper spacing between pregnancies and decreases unwanted pregnancies by 71% (PAHO. 30 Sep 2010). However, there is limited access to services that ensures that all women of reproductive age can prevent unwanted pregnancies. For instance, in 2019, in Colombia the government regulated the prices of contraceptive pills. Previously they could reach even 3 times its price in countries with a higher income level like UK or Canada.
A smart option for planning pregnancy and contraception is Natural Cycles mobile app. The company, originally founded in Switzerland and now based in Sweden, designed the technology to help women to track fertility. The algorithm in the app follows small changes in temperature that are associated to the natural cycle and predicts with high precision the days on which a woman is fertile. This technology is a medical device with the CE and FDA certification.
2) Reproductive and sexual education
Grace.Health is also an alternative for women and their communities with little access to health care services. The Swedish company developed a female health chatbot, providing users directly from experts with free, instant and accurate answers to sexual and reproductive health questions, risk factors, symptoms, and treatment options of common diseases. Grace is also CE-marked as a medical device.
3) Timely response of health services, communities and families
Monitoring devices could help to mitigate and to manage health issues. Wearable and mobile sensors, pressure monitoring devices, or smart textiles may provide remote monitoring of sub-clinical changes in pregnancy health status. It is especially beneficial for rural underserved populations and provides a cost-effective means for remote monitoring of higher risk women.
Bloomlife is a smart technology that allows visualising and tracking contractions at home, developed by a US-based company. This is a wearable sensor that is connected with a smartphone app to provide a comfortable way of contraction counting. The sensor is stuck to the belly and requires no straps. It is offered for both iOS and Android via a weekly rental.
4) Personalised monitoring during postnatal period
Most maternal deaths occur during the postnatal period. Analysing the state of maternal risks and conditions in real-time is helpful to propose solutions at different management levels. MamaMend is a childbirth recovery and postpartum health smartphone app. Based in the US, the startup offers telehealth physical therapy, and a personalised, evidence-based, week-by-week guide through several subjects, such as postpartum mental health, breastfeeding, thyroid health, and pelvic floor conditions.
The healthcare is being revolutionised, health workers will be digitally supported and most health care will be provided at home.
- In high-income countries, the changes to smart technologies in healthcare are being driven by the need to lower costs, whereas in low- and middle-income countries the driver is the poor access and quality of the care that is delivered and the explosion in access to digital and smart technologies.
- The highest growth of digital technologies is now in low-income countries, where according to the Pew Research Center, 84% of people in developing economies own a cell phone compared to 90% of people in the United States and people in emerging and developing nations are quickly catching up to those in advanced nations in terms of access to technology (Pouschter & Stewart. 2016. Smartphone ownership and Internet usage continues to climb in emerging economies but advanced economies still have higher rates of technology use. Pew Research Center).
- The adoption of users and healthcare providers of a technology is an essential but often overlooked component of the entire process of creating access to smart technologies. Thus, to achieve the implementation it is necessary (i) to assess the perceptions among patients and healthcare providers in incorporating these novel technologies, and (ii) to perform performance evaluation studies locally, in order to disseminate the results to external audiences.
- The cost of health technologies and related services is a key barrier to access in low- and middle-income regions; strategies to expand access must address affordability.
- Supply-side strategies that ensure the availability of a technology are needed to help expand access for health technologies in developing countries. Suppliers often lack complete information about product demand in those countries. Thus, manufacturers may underestimate the potential market and may not take the necessary steps to enter the market. Another access barrier relates to the difficulty of the manufacturers in finding compatible commercial partners in low- and middle-income countries. Strategies to address these problems include disseminating information to manufacturers about demand, potential partners, and assisting companies in product registration.
What is coming next?
At SupportA, we believe in the importance of knowing and acquiring up-to date data on Latin American markets to develop the best access strategy for innovative health care products. We are also aware that innovators can be overwhelmed by the disparity of governmental regulations within the region and by the myriad of cultural nuance differences. For the benefit of local patients and the progress of medical sciences, our ambition is to help innovators overcome these market access hurdles by providing concrete guidance in market compliance, business strategy, and clinical research management. Get in touch! We can identify the most relevant targets and implementation strategies for your technology.
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