Duke team brings life-saving function to ketchup packets

enovak@newsobserver.comJune 27, 2014 

Medicine from a ‘Pratt Pouch’ is administered to an infant in Tanzania. The invention came from Duke’s Pratt School of Engineering.


— Often innovation is not about telling a new story; it is about telling an old story in a new way. That is what Dr. Robert Malkin and his team of 30 Duke University undergrads did when they envisioned a new application for an all-too-familiar concept: condiment packets.

For Americans, these packets contain favored trimmings for hot dogs and hamburgers. But for mothers of newborns in developing nations, the packets can contain life-saving medication.

The invention, named the “Pratt Pouch” by Malkin and his team at the Pratt School of Engineering, is a foil pouch containing antiretroviral drugs that protect newborn babies against the transmission of HIV from their mothers.

It was recently recognized by the U.S. Global Leadership Coalition, a Washington-based network of corporations, nongovernmental organizations and other community leaders.

The recognition comes as part of the organization’s Innovations in Smart Power campaign, which looks at what spokesman Richard Parker calls hard power tools, such as the military, and soft power tools – development initiatives such as the Pratt Pouch.

According to the World Health Organization, about 3.4 million children, 91 percent of them in sub-Saharan Africa, were living with HIV at the close of 2011. To prevent the spread from mother to child, necessary medication such as AZT must be administered within 72 hours – and preferably 24 – of childbirth.

This becomes exceedingly difficult when more than half of mothers in many African countries deliver their babies at home. Even when the mothers give birth in clinics or hospitals, the initial dose of medication administered by the nurse or health professional is the only reliable dose.

“In utero and during breastfeeding, the mother is medicated during both of those periods, and that does help the baby. But that is not sufficient to protect the baby during delivery,” said Malkin, professor in the Department of Biomedical Engineering.

“The baby has to receive medication in order to be fully protected from the risk during delivery. And so up until now, there has been nothing available for that period of time during delivery for moms to deliver at home.”

The project began in late 2008 with the goal of discovering what was making current delivery methods of antiretroviral drugs so ineffective. The most common method is through a syringe, which cannot be provided to mothers in advance of delivery because transference to the syringe dilutes the drug’s potency.

With the Pratt Pouch’s packaging method, the life of the drug is extended by up to 12 months, enabling the pouches to be distributed to local pharmacies who then distribute the pouches to hospitals, clinics and rural communities. All the mother has to do is tear open the packet and squeeze the medication into her baby’s mouth – much like a packet of ketchup.

Malkin’s goal is to reduce the number of HIV-positive babies born every year from 400,000 to less than 100,000. Financial support for achieving this goal came from the National Institutes of Health, the President’s Emergency Plan for AIDS Relief, and two $250,000 grants from the United States Agency for International Development.

Clinical trials in Ecuador, Zambia and Tanzania have already proven promising, with successful prevention of HIV transmission for 49 Zambian mothers. With close to 3,000 home uses of the device, Malkin and his team have determined that the pouches have gained wide use and are being used correctly.

“Mothers who deliver at home typically have no way to get the medicine to their kids,” Malkin said. “In the Siavonga district where we have begun the project and rolled out the project in Zambia, 92 percent of women who deliver at home have access to the medications.”

The second indicator – accurate use – is being tested in Ecuador.

“The mom doesn’t have to know how to use a syringe, doesn’t have to know how to read ... they simply tear open the pouch and deliver it to the child,” Malkin said.

Next month, Malkin will be heading to Washington in hopes of returning with a $2 million grant from the U.S. Agency for International Development to expand the project to an entire country. The project is only intended for HIV-positive mothers who deliver at home, a situation that happens rarely if at all in the United States, yet it has been entirely funded by the U.S.

“This is a project which the U.S. is funding completely to the benefit of the rest of the world,” Malkin said.

Novak: 919-836-2891

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