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      Modeling the potential impact of emerging innovations on achievement of Sustainable Development Goals related to maternal, newborn, and child health

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          Abstract

          Background

          Innovations that improve the affordability, accessibility, or effectiveness of health care played a major role in the Millennium Development Goal achievements and will be critical for reaching the ambitious new Sustainable Development Goal (SDG) health targets. Mechanisms to identify and prioritize innovations are essential to inform future investment decisions.

          Methods

          Innovation Countdown 2030 crowdsourced health innovations from around the world and engaged recognized experts to systematically assess their lifesaving potential by 2030. A health impact modeling approach was developed and used to quantify the costs and lives saved for select innovations identified as having great promise for improving maternal, newborn, and child health.

          Results

          Preventive innovations targeting health conditions with a high mortality burden had the greatest impact in regard to the absolute number of estimated lives saved. The largest projected health impact was for a new tool for small-scale water treatment that automatically chlorinates water to a safe concentration without using electricity or moving parts. An estimated 1.5 million deaths from diarrheal disease among children under five could be prevented by 2030 by scaling up use of this technology. Use of chlorhexidine for umbilical cord care was associated with the second highest number of lives saved.

          Conclusions

          The results show why a systematic modeling approach that can compare and contrast investment opportunities is important for prioritizing global health innovations. Rigorous impact estimates are needed to allocate limited resources toward the innovations with great potential to advance the SDGs.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12962-017-0074-7) contains supplementary material, which is available to authorized users.

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          Most cited references6

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          Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails.

          We performed a systematic review to identify all studies evaluating the success rates of treatment of major postpartum hemorrhage by uterine balloon tamponade, uterine compression sutures, pelvic devascularization, and arterial embolization. We included studies reporting on at least 5 cases. All searches were performed independently by 2 researchers and updated in June 2006. Failure of management was defined as the need to proceed to subsequent or repeat surgical or radiological therapy or hysterectomy, or death. As the search identified no randomized controlled trials, we proceeded to search for observational studies. This identified 396 publications, and after exclusions, 46 studies were included in the systematic review. The cumulative outcomes showed success rates of 90.7% (95% confidence interval [CI], 85.7%-94.0%) for arterial embolization, 84.0% (95% CI, 77.5%-88.8%) for balloon tamponade, 91.7% (95% CI, 84.9%-95.5%) for uterine compression sutures, and 84.6% (81.2%-87.5%) for iliac artery ligation or uterine devascularization (P = 0.06). At present there is no evidence to suggest that any one method is better for the management of severe postpartum hemorrhage. Randomized controlled trials of the various treatment options may be difficult to perform in practice. As balloon tamponade is the least invasive and most rapid approach, it would be logical to use this as the first step in the management.
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            Sources and Focus of Health Development Assistance, 1990-2014.

            The governments of high-income countries and private organizations provide billions of dollars to developing countries for health. This type of development assistance can have a critical role in ensuring that life-saving health interventions reach populations in need.
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              Assessing the global availability of misoprostol.

              To assess the worldwide availability of misoprostol. Documenting the extent of misoprostol use in obstetrics-gynecology is difficult because the drug typically is unregistered for such indications. Data for 2002-2007 on annual sales (measured in weight) to hospitals and retail pharmacies, plus manufacturer prices per 200-microg misoprostol, were analyzed for medications containing misoprostol alone or combined with a nonsteroidal anti-inflammatory drug (NSAID); regional and country-specific trends were identified. Consumer prices per pill are documented for all formulations of registered medications. Of the misoprostol sold worldwide, 70% was misoprostol-NSAID-combination drugs; of this, 91% was sold in North America and Western Europe. Asia sold the most misoprostol-only drugs; sales increased dramatically in Bangladesh (by 128%) and India (646%), where various low-price brands are sold. Misoprostol sales decreased in Latin America but increased in the Middle East-North Africa and Sub-Saharan Africa; these regions generally had low amounts sold per population. Availability is improving in some low-income regions where misoprostol could significantly reduce maternal deaths due to postpartum hemorrhage and unsafe abortion.
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                Author and article information

                Contributors
                therrick@path.org
                charner@path.org
                cshaffer@appliedstrategies.com
                gzwisler@path.org
                pdigre@path.org
                abatson@path.org
                Journal
                Cost Eff Resour Alloc
                Cost Eff Resour Alloc
                Cost Effectiveness and Resource Allocation : C/E
                BioMed Central (London )
                1478-7547
                12 July 2017
                12 July 2017
                2017
                : 15
                : 12
                Affiliations
                [1 ]ISNI 0000 0000 8940 7771, GRID grid.415269.d, , PATH, ; 2201 Westlake Ave. Suite 200, Seattle, WA USA
                [2 ]Applied Strategies, 951 Mariners Island Blvd. Suite 400, San Mateo, CA USA
                Article
                74
                10.1186/s12962-017-0074-7
                5506623
                17b4c742-f62f-4a1a-9659-dd9e12de7107
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 September 2016
                : 3 July 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;
                Award ID: OPP1114069
                Funded by: FundRef http://dx.doi.org/10.13039/100000200, United States Agency for International Development;
                Funded by: FundRef http://dx.doi.org/10.13039/100007843, Direktoratet for Utviklingssamarbeid;
                Award ID: 1400256
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Public health
                Public health

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