The App Helping Africa’s Midwives Save Lives

This article first appeared on the Women & Girls Hub from News Deeply

A mobile health project in Ethiopia gives any health worker with a smartphone access to the information they need to deal with emergencies during childbirth. Now it’s being scaled up to reach 10,000 health workers across Africa and Southeast Asia by 2017.

A midwife at Gimbi Health Center in West Wellega, Ethiopia, uses the Safe Delivery App to help her carry out an examination on a patient. Photo by Mulugeta Wolde

For Ethiopian mother Mitike Birhanu, the birth of her twins almost ended in tragedy. She was unconscious when the second of her babies was delivered, and the newborn seemed lifeless. But her midwife quickly consulted an app on her smartphone, diagnosed the problems, and used emergency procedures to save both Mitike’s life and that of her child.

Every year, over 300,000 women globally die from pregnancy-related causes, and over 5 million babies die during birth or within the first weeks of their lives. Yet the vast majority of maternal and newborn deaths could be prevented if health workers attending births had better emergency skills and knowledge.

Many health workers in low- or middle-income countries work in environments where there is no electricity or running water. But one thing they do have is smartphones.

The Safe Delivery App (SDA) was created as a simple tool for health workers such as midwives and nurses to access basic emergency obstetric and neonatal care skills. Developed by Danish NGO Maternity Foundation in collaboration with the University of Southern Denmark and the University of Copenhagen, the app aims to train and instruct birth attendants on how to manage potentially fatal complications during pregnancy and childbirth.

Based on global clinical guidelines, the SDA contains four basic features: animated instruction videos, action cards, a drug list and practical procedure instructions. The five- to seven-minute videos teach lifesaving skills such as how to stop a woman bleeding after birth or how to resuscitate a newborn. When there is no time to watch the full video, the action cards give clear, essential recommendations and immediate care information – such as how to mix an alcohol-based hand rub.

The SDA is free to download from Google Play and the App Store. And it can be preinstalled on phones, so once it’s downloaded, users don’t need a network connection or internet access to view the videos or other features.

Meaza Semaw, project coordinator at the Ethiopian Midwives Association, says the app is ideal for places like Ethiopia, where women’s access to quality maternal health services is challenging, especially if they experience complications in birth. “The Safe Delivery App is a great tool to improve maternal health in Ethiopia. Most midwives, if not all, have a mobile phone, so accessibility is very high,” she says. “The app is easy to use because it is supported by animations and videos. In addition, it uses local languages.”

With the support of the MSD for Mothers program, the first four of the app’s 10 videos were tested in a one-year, randomized controlled trial across 78 facilities in Ethiopia during 2014. Results show users’ skills in handling most common complications such as postpartum hemorrhage and newborn resuscitation more than doubled after 12 months of using the app.

The app was officially launched in April 2015, and a year later was chosen by the Women Deliver conference as an example of how a partnership-based innovation can help end maternal and newborn mortality. SDA is now currently in use in Kenya, with plans to roll out to Guinea, Sierra Leone, Myanmar, Laos and India in the coming months.

So far, the app has been funded with help from over $50,000 in donations through an Indiegogo crowdfunding campaign, and Maternity Foundation is working with partners in individual countries to fund the translation and rollout of the app. The hope is to be able to fulfill the commitment Maternity Foundation made to the U.N.’s Every Woman Every Child to reach 10,000 health workers with the app by the end of 2017, so ensuring a safer birth for 1 million women.

At Wollega University in Ethiopia, student midwives use the app during training. (Mulugeta Wolde)At Wollega University in Ethiopia, student midwives use the app during training. (Mulugeta Wolde)

Maternity Foundation CEO Anna Frellsen says the organization is working in partnership with governments, midwives’ associations and larger NGOs to achieve its goal. “We really want to see the app integrated as part of the existing health system in countries, and we are starting to engage with the [health] ministries and stakeholders in each country to find out how it can be used and adapted,” she says.

The Ethiopian Midwives Association is currently working on integrating the SDA into its ongoing training program. Frellsen hopes other health organizations in participating countries will do likewise.

There is also a new version of the app in the works, which will feature quizzes and a test (rewarded by a certificate) to “push” learning to the user and make the experience more interactive.

Frellsen says one of the key components of Maternity Foundation’s “backbone” support for its partners will be disseminating learning around the SDA and mobile health in general. “We are looking at how we can publish some of the learning for sharing with others who would like to use the app, but also more broadly as a case for how to scale up an mHealth [mobile health] tool,” she says.

In western Ethiopia’s Gimbi rural district, the midwife who saved Mitike’s life says the Safe Delivery App has already made her better at her job. “I am confident that from what I have learned from the app, I can stop [a mother] bleeding,” says Yane Ababaw. “I can save her life.”

Crucial questions for journalists during the refugee crisis

Credit: Nando Sigona

Credit: Nando Sigona

This article first appeared on the 19 Million Project website

“We need to humanize the refugee crisis,” UK-based migration specialist Nando Sigona told the 19 Million Project audience in Rome during a Skype interview on Wednesday.

Sigona, senior lecturer in migration and citizenship at the University of Birmingham in England, challenged journalists to look at the stories behind the stats, rather than treating people as “generic refugees”.

What is it like to spend four years in a refugee camp? What are the issues facing the generation of children born in camps? These are some of the questions that journalists should be asking, said Sigona. “Attempts to humanize are very important.”

Sigona urged journalists to remain inclusive about their coverage of migration stories, given the inter-sectionality of refugees: “There is a risk in the representation of ‘good’ refugees versus ‘bad’ ones,” he said. “Who does deserve our protection? Syrians are not the only ones who do.”

And while data can be a powerful tool, Sigona cautioned users to keep an eye on the bigger picture. “Numbers have power but we need to pay much more attention to how numbers are used,” he said, citing the “complete conflation” of immigration with figures on arrivals by the sea.

Measures to promote integration of refugees in their host countries vary wildly. But Sigona says he is encouraged by positive actions emerging from the Mediterranean crisis, such as Germany translating its constitution into Arabic and offering English as well as German language courses, to assist incoming refugees.

A key issue for journalists to consider over the coming months, says Sigona, is the “economy of the crisis” and its beneficiaries – such as security contractors employed by EU border management agency, Frontex. “Who is making money out of it?”

Doing the funny business: why Red Nose Day USA paid off

RED NOSE DAY -- Season: 1 -- Pictured: Seth Meyers onstage at NBC's

Red Nose Day host Seth Meyers onstage at the NBC telethon (Photo: Virginia Sherwood/NBC)

This article originally appeared in The Guardian

Launching a national fundraising event in a country of 320 million people and multiple time zones may seem like an ambitious gamble. But UK charity Comic Relief hopes the first Red Nose Day USA, which culminated on 21 May with a telethon raising over $21m (£13.6m), will prove to be worth the risk.

Red Nose Day USA builds on the success of its UK namesake which, since its launch in 1988, has raised more than £1bn to help 50 million people in the poorest communities at home and abroad.

The biennial Red Nose Day UK fundraiser encourages people to “do something funny for money” in their school, community or workplace. It concludes with a live TV show and telethon on BBC1, which in March 2015 raised over £78m and attracted 8.5 million viewers.

Around 3.2 million viewers watched the inaugural Red Nose Day USA’s slick, three-hour broadcast from New York featuring live comedy sketches, musical performances and pre-recorded acts.

The US show also included pre-recorded celebrity reports from the field (Jack Black in Uganda and Michelle Rodriguez in Peru) and household name hosts (Seth Meyers, David Duchovny and Jane Krakowski) to urge viewers to donate during the show.

Twelve non-profit organisations in the US and worldwide will benefit from the first Red Nose Day USA, from Boys & Girls Clubs of America to international vaccination organisation, Gavi.

Red Nose Day USA is run by Comic Relief Inc as an independent sister organisation of Comic Relief UK – the charity set up in 1985 by screenwriter Richard Curtis in response to famine in Ethiopia.

Comic Relief innovation director, Amanda Horton-Mastin says the idea of a US Red Nose Day had been percolating for some time: “We share the same language, the US is an amazingly generous population and we have a lot of shared comedy.”

Campaign challenges

Given the scale of the US, it was essential to have an effective network partner so the team was delighted to secure NBC, which worked with its affiliates to promote the event locally. “With the BBC and two or three media partners you can reach everyone in the UK,” Horton-Mastin explained. “The fragmentation of the media [in the US] is a massive challenge.”

Another challenge was building brand awareness in a country where red noses mean Rudolph, not raising money: “Nobody knew us – we were starting from zero awareness.”

Walgreens – the pharmacy chain with 8,232 outlets across the US – was chosen as exclusive retailer of the campaign’s trademark red noses and other select products from vendor partners such as Mars, Kraft and Coca-Cola. Sales of these items, combined with fundraising by Walgreens’ employees and customers, raised over $8m while embedding the campaign at community level.

Bringing a new fundraising brand to market within just a few months meant that social media was a crucial element of the campaign. NBC created a dedicated app which enabled users to add a red nose image to a new or existing photo, then share on Facebook, Instagram or Twitter. Building on this, Red Nose Day USA partner M&M’s asked people to make someone laugh then share their story with the hashtag #MakeMLaugh, in return for a $1 M&M’s donation to Red Nose Day. The campaign hit its $250,000 target and raised $1.25m from M&M’s.

Additionally, the Bill & Melinda Gates Foundation pledged $25 for each photo posted on Twitter or Instagram by 1 June with the hashtag #RedNose25, up to a total $1m.

RED NOSE DAY -- Season: 1 -- Pictured: Gwyneth Paltrow onstage at NBC's

Gwyneth Paltrow makes an entrance at the Red Nose Day telethon (Photo: David Giesbrecht/NBC)

Content is king

Creating a rich source of newsworthy content that could go viral was another priority. “Content is king so we wanted to make the entertainment really strong,” Horton-Mastin added.

Telethon night highlights included a Game of Thrones mock musical by Coldplay that has attracted over 7m hits on YouTube, The Voice winner Sawyer Fredericks’ rendition of John Lennon’s Imagine and an acoustic duet by Ed Sheeran and Kermit the Frog of the Muppet Movie song, Rainbow Connection.

The strategy appears to have paid off. According to Nielsen’s Twitter TV ratings – which map the social conversation around a telecast three hours before and after the event – four million people across the US saw 149,000 Red Nose Day tweets, making it the third most social TV event of the week, behind only the NBA Draft Lottery and David Letterman’s final Late Show.

Other countries including Iceland, Finland, Germany and South Africa have hosted their own events based on Red Nose Day or Sport Relief, usually run under licence from Comic Relief. In Australia, a Red Nose Day has existed since 1987 as the main annual fundraiser for SIDS and Kids, a national charity supporting families affected by infant death. Horton-Mastin said Comic Relief will continue to look at opportunities to expand the brand where there is a giving culture and a TV culture.

In the meantime, Horton-Mastin hopes Red Nose Day USA will become an annual event: “We’ve been very optimistic and have huge aspirations, because our mission is about driving positive change using the power of entertainment.”

Feeding the spirit

Between Meals 1 (not in final)

As featured in The Guardian’s Pick of the blogs

As newly-arrived refugees and immigrants navigate the myriad challenges in their new environments, it is often food and its important cultural traditions that are the mainstay in this journey.

Between Meals collects stories and recipes from California’s refugee women to paint a picture of their lives, past and present. The cookbook chronicles the experiences of women leaving their homes in Afghanistan, Burma, Somalia, Sri Lanka and beyond, and the vital role that traditional cooking plays at every stage of the process.

From the malawah flatbread that Somali refugee Halimo cooked each day in the Dadaab refugee camp, to Afghan newcomer Arezo’s celebratory jalebi sweet, every recipe tells a story.

Between Meals 5

Memory box

Cookbook author Lauren Markham sees Between Meals as both a preservation project – a recipe “memory box” from the US diaspora communities – as well as a reflection on the creative process by which refugee and immigrant women put down roots in their new homes.

It highlights the challenges that women face when adapting their food to new communities, from locating a goat farm an hour’s drive away, to tracking down galangal root at a Chinatown market.

Between Meals is a project of San Francisco Bay Area non-profit agency, Refugee Transitions, which supports newly-arrived refugees and immigrants into their new communities through education, family engagement and community leadership programs.

Funded by Cal Humanities, the cookbook was developed from Refugee Transition’s home-based tutoring program, where shared meals are often core to the student-tutor relationship.

Between Meals 3

Making connections

Executive director Laura Vaudreuil says that, for those who have had to leave all behind, sharing a meal means more than just sharing food: “When all that is left are memories of home, the smells, tastes and experience of a meal recreated can take people back to friends and family.”

Arezo enjoys making her mantu Afghan dumplings for family and new friends. “Mantu is special to me because my mother made it for me the day I found out I was pregnant with my first child.

“I make mantu in California, especially when I miss Kabul and my family in Afghanistan.”

Between Meals is available to order here Profits from the book will be distributed among the cookbook contributors. 



Brands continue to target fast food marketing at kids

child eating beefburger

Each year, the world’s food and beverage companies spend billions on marketing and advertising their products to children and teenagers. The overwhelming majority of these products are high in calories, added sugar, saturated fat and sodium – fast food, fizzy drinks, sweets and chocolate to name just a few. Ask your child to recall a food advert and chances are that it won’t be one for apples or broccoli.

US fast food restaurants alone spent $4.6bn on advertising to children and teens in 2012. According to Fast Food Facts 2013, children under six saw almost three adverts for fast foods every day, while 12-17-year-olds saw almost five adverts a day.

Between 2010 and 2013, the number of kids’ meals at fast-food restaurants increased by 54%. But the percentage of items that qualified as healthy – less than 1% – remained stagnant.

Report lead author Jennifer Harris, director of marketing at the Yale Rudd Center for Food Policy & Obesity, is concerned that many companies are shifting their focus to increase reach into markets not currently covered by the current system of voluntary self regulation.

“A lot of companies have switched their marketing target to the 12-14 [age] group. This is a really vulnerable time for kids; they are seeing more media and making more decisions on their own,” Harris says.

Around one in three children in the US – and in the UK – is overweight or obese. A study published this month by Roberto De Vogli of UC Davis in California found that fast food purchases were independent predictors of increases in the average body mass index (BMI) in the US and 24 other wealthy nations between 1999 to 2008.

So what is business doing?

Encouraging food and drink companies to rethink their messages is the aim of the first White House convening on food marketing to children. Launching the meeting last September, US First Lady Michelle Obama called on the private sector to “move faster” to market responsibly to children.

In January 2014, Subway became the first quick service chain to join Partnership for a Healthy America, a campaign endorsed by Obama to bring together business, non-profits and health advisers to tackle childhood obesity. A three-year commitment worth $41m will see it market healthier options and promote fruit and veg consumption.

Disney has pledged that by 2015, all food and beverage products advertised, sponsored, or promoted on Disney-owned media channels, online destinations and theme parks will be required to meet nutritional guidelines that align with federal standards to promote fruit and vegetables and limit calories, sugar, sodium, and saturated fat.

Earlier this year, Lidl became the first supermarket group in the UK to remove unhealthy products from all tills across its stores, with no seasonal exceptions for Christmas or Easter confectionery. Lidl is replacing these products with healthier options including fresh and dried fruits, nuts and bottled water.

Should regulation be playing a bigger role?

In the UK, regulation exists to prevent adverts for unhealthy foods from being broadcast during or around programmes specifically made for children. But the Children’s Food Campaign (CFC) argues that the popularity of family entertainment shows like The X-Factor means later bedtimes for many children – and advertisers are taking advantage by promoting unhealthy foods at these times.

In a joint campaign with the British Heart Foundation, the CFC will next month call for a 9pm watershed for fast food and drinks ads and clearer definition of ‘healthy’ and ‘unhealthy’ foods, to close existing loopholes.

But the ISBA, which represents British advertisers, argues that the causal link between the ads that viewers watch, and the food choices they make, is “nominal”, and ad prohibitions are currently viewed at the “silver bullet” for tackling a complex public health issue.

Ian Twinn, ISBA’s director of public affairs says: “Encouraging people to change their lifestyle rather than slapping bans on ads is what will make a difference.

“There are plenty of good examples of big brands changing their messages to ensure they stay relevant to their consumers but support the overall message for a healthier lifestyle. Coca-Cola, for instance, only advertises its low calorie or sugar-free products.”

The UC Davis study suggests that if governments take action to control food industries, they can help prevent obesity and its serious health consequences, including cardiovascular disease and diabetes. This echoes calls in the UK and US for more robust, government-led regulation of the industry, rather than voluntary self-regulation.

In the UK, the CFC hopes the government’s food promotion pledge – expected late spring as part of its public health responsibility deal – will target point-of-sale, product packaging, digital marketing and in-school promotion.

Beyond the supermarket

The CFC’s Junk Free Checkouts campaign, launched last September, challenged supermarkets to act on consumer concerns about “pester power” and remove unhealthy snacks from checkouts and queuing areas. Shoppers were urged to hand in pass or fail cards to store managers, and name and shame supermarkets via a dedicated website.

Malcolm Clark, CFC co-ordinator, says: “The government’s responsibility pledge covers supermarkets, but WH Smith and Boots have chocolate at the checkout, so the question will be whether they engage with the other companies.”

Dr Emma Boyland, a psychologist at the University of Liverpool who specialises in the effects of food marketing on children’s diets, says the next challenge is to tackle promotion to children via advergaming and social media.

“The cross-border nature of this [area] means that government can only tackle A little progress has been made with TV but advertising has moved to the Internet.. and into another sphere.”