The Evaluation of Technologies for Neonates in Africa (ETNA)

Globally, 47% of deaths of children younger than 5 years occur within the first 28 days of life, with sub-Saharan Africa bearing the highest burden, with the average neonatal mortality rate being 18 deaths per 1000 live births. Neonatal death can be prevented by achieving high coverage of high-quality, evidence-based, and timely interventions. To meet the Sustainable Development Goal target of reducing global neonatal mortality to 12 deaths per 1000 live births by 2030, accelerated improvements and innovations in neonatal care in Africa, particularly technologies that allow for early detection and intervention for major morbidities, are needed to reduce current and projected neonatal mortality rates.

The Evaluation of Technologies for Neonates in Africa (ETNA) platform was conceived to advance and support the development and evaluation of select devices, specifically for managing at-risk newborns and children in Africa, where the need for such tools is greatest. The ETNA testing platform provides opportunities for technology optimisation through rounds of clinical testing and re-evaluation in the target population. We are exploring whether selected multiparameter, continuous physiological monitoring (MCPM) devices that have already been tested for safety can accurately and reliably measure vital signs in neonates. We are assessing the feasibility, usability, and acceptability of these devices for use in neonates.

Multiparameter continuous physiological monitoring devices could be instrumental in directing care provided for a neonate through automatic interpretations of vital signs that help identify critical events and determine if treatment is sufficient or insufficient, ultimately improving newborn outcomes. These devices would be most beneficial in low-resource settings (LRS) in sub-Saharan Africa, where the need for such technologies is greatest. While such devices currently exist and are standard of care in high-resource settings, they are expensive and require specialized training to operate, making them unsuitable for application in LRS. To address these barriers, it is necessary to explore how these technologies can be adapted and optimized for use in LRS. Ideally, the devices should be low-cost, operator-independent, and highly efficient in diagnostic performance and operator workload. This requires developing a robust testing platform that appropriately mimics conditions common in an African newborn unit or neonatal intensive care unit (NICU) that would allow these types of technologies to be evaluated for performance and feasibility.

Our goal is to advance and manage the development and evaluation of select devices for use in neonates. By establishing a testing platform in an African site and working collaboratively with partners with expertise in device development and evaluation and neonatal and child health, the project seeks to boost the development and optimization of promising newborn care devices that could be applied in LRS in Africa.

ETNA is led by Dr. William Macharia at Aga Khan University in Nairobi, Dr. Amy Ginsburg from the University of Washington, and Dr. Mark Ansermino, generously funded by the Bill and Melinda Gates Foundation.  Centre for International Child Health has been involved in supporting the data analysis components for ETNA.

Interested in learning more about the project? Contact Bella Hwang at

SOURCE: The Evaluation of Technologies for Neonates in Africa (ETNA) ( )
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