Fetal Distress

Project will combat infant mortality rates and lessen fetal distress in East Africa TATU CITY, Kenya, March 6, 2024 /PRNewswire/ -- The governments of the United States, Finland and Canada are funding a sustainable, accessible and affordable medicinal oxygen manufacturing facility at Tatu City Special Economic Zone (SEZ), the 5,000-acre new city on Nairobi's doorstep. Hewatele, a medical oxygen producer in Kenya, has secured a USD 20 million funding package from the U.S. International Development Finance Corporation (DFC), Finnfund, Soros Economic Development Fund (SEDF), UBS Optimus Foundation and Grand Challenges Canada. Hewatele will use the debt and equity funds raised to finance the building of a cutting-edge Cryogenic Medical Liquid Oxygen Air Separation Unit plant at Tatu Industrial Park. Set to commence operations in late Q1 2025, the facility will be the first modern liquid oxygen manufacturing plant located in East Africa in the last 60 years and help fill the escalating demand for medical-grade liquid oxygen in healthcare facilities across Kenya, Uganda and Northern Tanzania. "Hewatele's investment, backed by the world's preeminent development finance institutions and foundations, represents a transformation of healthcare in Kenya and across East Africa," said David Karimi, Deputy Country Head, Kenya, at Rendeavour, the owner and developer of Tatu City. Dr Bernard Olayo, Founder of Hewatele, said: "This medical oxygen plant represents a significant leap in ensuring sustainable and affordable access to medicinal oxygen. The increased production capacity here at Tatu City will improve oxygen affordability, particularly for maternal and child healthcare, and enhance primary healthcare support." According to Kenya's Ministry of Health, demand for medical oxygen has increased significantly since the COVID pandemic, from 410 tons per month to 880 tons per month. As a result, Kenyan hospitals frequently experience unpredictable deliveries, higher prices, and expensive transportation costs for medical oxygen. Due to the high production costs, fragmented delivery and storage options, medicinal oxygen is typically eight to ten times more expensive in sub-Saharan Africa than it is in Europe and North America. Hewatele's facility will boost production of medical oxygen by least 20 tons per day, reducing the cost to its rural and urban healthcare customers by up to 30%. Improving access to oxygen and administering oxygen can reduce child mortality from pneumonia by 35% and lessen foetal distress and save lives when given to women during pregnancy. "The rise of the COVID pandemic made everyone around the world aware of the importance of oxygen supply," said Johanna Raehalme, Finnfund's Head of Origination in Africa. "We are happy to add yet another important investment in our healthcare portfolio and see that the increased awareness of oxygen will ensure market demand for Hewatele going forward." Georgia Levenson Keohane, CEO of SEDF, said: "As a catalytic social impact investor focused on direct impacts and longer-term, systemic change, SEDF sees the investment in Hewatele as an important commitment to strengthening Africa's rapidly expanding healthcare sector." Maya Ziswiler, CEO Optimus Foundation, said: "UBS Optimus Foundation invests in organizations that demonstrate clear impact and innovative and scalable business models. That's why we were early supporters of Hewatele, as we see the impact and value of their business model and are now pleased to make a longer-term commitment for them to reach even more undersupplied rural and urban communities in East Africa with affordable and life-saving medical oxygen." "With our first base in Western Kenya, our expansion to Tatu City will create 50 new direct full-time jobs and over 100 indirect jobs, stimulating the local economy. We are honoured to be part of the healthcare ecosystem in Kiambu County," added Dr Zulfiqar Wali, CEO of Hewatele. More than 75 local, regional and global businesses are operational or under development in Tatu City's business-friendly location, including CCI Global, Heineken, Dormans, Copia, Cooper K-Brands, Grit Real Estate Income Group, Twiga Foods, Freight Forwarders Solutions, ADvTECH, Friendship Group and Davis & Shirtliff. More than 3,000 homes and apartments are occupied or under construction, and 4,500 students study at Tatu City's schools. About Hewatele () Hewatele is a pioneering medical solutions provider committed to enhancing healthcare services in East Africa. With a focus on innovation and sustainability, Hewatele strives to address critical healthcare challenges and contribute to the well-being of communities. Hewatele, together with its affiliates CPHD (The Center for Public Health and Development) and Mediquip Global, provides all-around oxygen solutions to all needy patients. About Tatu City () Tatu City is a 5,000-acre new city on Nairobi's doorstep with homes, schools, businesses, a shopping district, medical clinic, nature areas and recreation for more than 250,000 residents and tens of thousands of day visitors. Tatu City's schools educate thousands of students daily, a range of homes suits all incomes and more than 75 businesses thrive in the country's first operational Special Economic Zone. Located 30 minutes from Westlands, Tatu City represents a new way of living and thinking for all Kenyans in a live, work and play environment that is free from traffic congestion and long-distance commuting. Tatu City is a development by Rendeavour, Africa's largest new city builder, with 30,000 acres of visionary projects in growth trajectories across Ghana, Nigeria, Kenya, Zambia and the Democratic Republic of Congo. Rendeavour is backed by American, New Zealand, British and Norwegian investors. SOURCE Tatu City SEZ

External heart rate monitoring, the most common method of monitoring the fetus, may leave signs of fetal hypoxia undetected if the maternal pulse rate is not simultaneously monitored. The risk is that the fetal heart rate is masked by the maternal pulse, with fetal distress going unnoticed. Cardiotocography (CTG) refers to the electronic recording of the fetal heart rate and uterine contractions. Fetal heart rate recorded through the mother's abdomen is the most commonly used fetal monitoring method during childbirth. Now, a research team from the University of Helsinki and Helsinki University Hospital (HUS) has found that external fetal heart rate monitoring without simultaneous maternal pulse recording is associated with both an increased risk of neonatal encephalopathy and acidemia in fetal umbilical artery blood, i.e., critically low pH and base excess concentrations. Acidemia increases the need for newborn resuscitation and the length of intensive care. The study, published in the esteemed American Journal of Obstetrics and Gynecology, analysed almost 214,000 spontaneous full-term births in HUS maternity hospitals between 2005 and 2023. The study included the largest CTG dataset ever published. The study demonstrated that a newborn monitored during labour with external fetal heart rate monitoring alone had a 1.6-fold risk of neonatal encephalopathy and a 2.3-fold risk of severe umbilical cord blood acidemia compared to those monitored with an internal electrode attached to the skin of the fetal head (internal monitoring) or by concurrent external fetal heart rate monitoring and maternal pulse recording. "Especially during the second stage of labour, when mothers tend to display increased heart rate while pushing, fetuses more commonly exhibit heart rate decelerations. Consequently, the fetal heart rate can be quite easily mixed with the maternal pulse, in which case abnormal fetal heart rate tracing, indicating fetal hypoxia, may go unnoticed by professionals," says Researcher Mikko Tarvonen, describing the challenges of external CTG monitoring. In the majority of the labours in the study (38%), solely external monitoring was used. Internal monitoring was the second most common method (33%), followed by external monitoring simultaneously with maternal pulse recording (29%). Years of safer practice at HUS The world's largest organisations of obstetricians and midwives recommend in their fetal monitoring guidelines that external fetal heart rate monitoring be used as the primary CTG registration method. However, the new study indicates that, without simultaneous maternal pulse recording, this method is a significant risk factor predisposing the fetus to labour-related hypoxia and its long-term neurological effects. "Based on our results, this tragedy can be effectively prevented by combining maternal pulse recording with fetal heart rate monitoring. This method allows professionals to be sure of whose heart rate they are monitoring," says Tarvonen. In 2019 HUS adopted a new protocol emphasising the necessity of recording maternal heart rate alongside fetal heart rate during childbirth. "Practices have long varied at Finnish maternity hospitals, but training and research evidence have resulted in a shift in attitudes and thus the increased use in recent years of maternal pulse monitoring," Tarvonen notes. The present study demonstrated that, based on the incidence of neonatal encephalopathy, external fetal heart rate monitoring combined with maternal heart rate recording is equally as safe as internal fetal monitoring. However, internal monitoring was the most accurate way of assessing fetal wellbeing. Its use was associated with the lowest incidence of hypoxia-related neonatal outcomes. The incidence of both neonatal encephalopathy and severe umbilical artery blood acidemia has decreased significantly in the HUS region during the study's 18-year follow-up period. "This trend is exceptional even by international standards," Tarvonen points out. Facts: Monitoring the wellbeing of the unborn child through cardiotocography (CTG)

FRIDAY, July 21, 2023 – In the two decades since the opioid epidemic took off, the addiction crisis has claimed the lives of hundreds of thousands of Americans. Now, new research points to another grim outgrowth of the crisis on American health: a skyrocketing risk in pregnant women for hepatitis infection (HCV). That’s because the main risk factor for contracting hepatitis C — a liver infection spread by blood contact -- is injection drug use. Between 1998 and 2018, prevalence of HCV among pregnant women shot up 16-fold, researchers found, driving up the risk for poor fetal development and fetal distress, as well as preterm birth. And that’s just the broad picture among pregnant women of all ages. Among those between 21 and 30, hepatitis C risk shot up more than 3000%. “We do think the increase in HCV infections among pregnant women in our data is concerning,” noted lead author Dr. Po-Hung (Victor) Chen , an assistant professor of medicine Johns Hopkins University School of Medicine's Comprehensive Transplant Center in Baltimore. If anything, he said, concern should be even greater that the number cited in the study might suggest that U.S. obstetricians did not routinely screen all pregnant women for HCV during the study period. “Therefore our findings likely even underestimated the true number of HCV infections among pregnant women in the U.S.,” Chen added. Hepatitis C is the most commonly reported chronic blood-borne infection in the United States, researchers said. Generally, it is symptom-free, until liver disease sets in. Without timely screening and diagnosis, untreated hepatitis C can lead to liver inflammation, cirrhosis and cancer. Chen said the link to the opioid crisis stems from the sharing of needles and syringes, given that HCV is spread via blood. Between 1999 and 2020, more than 564,000 people died from an opioid overdose, according to the U.S. Centers for Disease Control and Prevention. For this study, Chen's team examined data for more than 70 million women between 18 and 50 who were hospitalized between 1998 and 2018 to give birth or as a result of a miscarriage. Just over 137,000 tested positive for hepatitis C. Roughly three-quarters of the infected women were white and about two-thirds were under 31. Nearly 3 in 10 reported opioid use. By the final year of the study period, researchers found, 5.8 of every 1,000 pregnant women were positive for HCV — a 16-fold increase. During that two-decade timeframe, pregnant women between the ages of 41 and 50 also saw their hepatitis C risk rise — by 300%. HCV risk among the largest group of women — those between the ages of 21 and 30 — rose much more dramatically, increasing 31-fold (or roughly 3100%). “These were not merely risks or hypotheticals,” Chen emphasized, but actual numbers seen among U.S. women. While suggesting that evidence of an opioid epidemic-HCV link is "compelling," Chen conceded that this study does not definitively prove that the opioid crisis directly caused the HCV rise seen in pregnant women. But he added that it indicates that universal HCV screening with each pregnancy makes sense. “However," Chen added, "Screening is just the first step. We need additional research on best practices for connecting mothers and their infants who screened positive for HCV to specialists who can help them.” The findings were published July 21 in the journal JAMA Network Open . Dr. David Bernstein is a professor at NYU Grossman School of Medicine and the new director of ambulatory gastroenterology and hepatology at NYU Langone Long Island in New York City. He said the findings came as no surprise. “We have been seeing signs of big increases in the prevalence of hepatitis C among young women and men due to the opioid crisis in this country,” Bernstein noted. "And since we’re not adequately addressing the opioid crisis, we’re going to continue to see young women who become pregnant who have hep C. And that’s going to place their child at risk of acquiring it at birth.” Bernstein noted that between 3% and 5% of infants born to an HCV-infected mother will have the disease themselves. The good news: “Once identified, hep C is treatable and curable in more than 95% of people who have the infection,” he added. Even so, Bernstein stressed that the study highlights something that everyone in the field knows: To address risks such as HCV, " a lot more resources" must be invested in addressing the opioid crisis. “The crisis is only getting worse,” he said. “And that’s unfortunate. Because this sort of thing is 100% preventable.” Sources Po-Hung (Victor) Chen, MD, PhD, assistant professor, medicine, Division of Gastroenterology and Hepatology, Comprehensive Transplant Center-Liver Transplant, Johns Hopkins University School of Medicine, Baltimore David Bernstein, MD, professor, medicine, NYU Grossman School of Medicine, and director, ambulatory gastro-enterology amd hepatology, NYU Langone Long Island, New York City JAMA Network Open , July 21, 2023 Posted July 2023