Each day, approximately 830 women and 7,400 newborns die from complications during pregnancy and childbirth. Improving maternal and neonatal health will require bringing rapid diagnosis and treatment to the point of care in low-resource settings. However, to date there are few diagnostic tools available that can be used at the point of care to detect the leading causes of maternal and neonatal mortality in low-resource settings. Here we review both commercially available diagnostics and technologies that are currently in development to detect the leading causes of maternal and neonatal mortality, highlighting key gaps in development where innovative design could increase access to technology and enable rapid diagnosis at the bedside.

Many assays for biological sample processing and diagnostics are not suitable for use in settings that lack laboratory resources. We have recently described a simple, self-contained format based on magnetic beads for extracting infectious disease biomarkers from complex biological samples, which significantly reduces the time, expertise, and infrastructure required. This self-contained format has the potential to facilitate the application of other laboratory-based sample processing assays in lowresource settings. The technology is enabled by immiscible fluid barriers, or surface tension valves, which stably separate adjacent processing solutions within millimeter-diameter tubing and simultaneously permit the transit of magnetic beads across the interfaces. In this report, we identify the physical parameters of the materials that maximize fluid stability and bead transport and minimize solution carryover. We found that fluid stability is maximized with 0.8 mm i.d. tubing, valve fluids of similar density to the adjacent solutions, and tubing with 20 dyn/cm surface energy. Maximizing bead transport was achieved using !2.4 mm i.d. tubing, mineral oil valve fluid, and a mass of 1-3 mg beads. The amount of solution carryover across a surface tension valve was minimized using 0.2 mg of beads, tubing with 20 dyn/cm surface energy, and air separators. The most favorable parameter space for valve stability and bead transport was identified by combining our experimental results into a single plot using two dimensionless numbers. A strategy is presented for developing additional self-contained assays based on magnetic beads and surface tension valves for low-resource diagnostic applications.

Three-part differential white blood cell counts are used for disease diagnosis and monitoring at the point-of-care. A low-cost, miniature achromatic microscope was fabricated for identification of lymphocytes, monocytes, and granulocytes in samples of whole blood stained with acridine orange. The microscope was manufactured using rapid prototyping techniques of diamond turning and 3D printing and is intended for use at the point-of-care in low-resource settings. The custom-designed microscope requires no manual adjustment between samples and was successfully able to classify three white blood cell types (lymphocytes, granulocytes, and monocytes) using samples of peripheral whole blood stained with acridine orange.

Being able to perform a white blood cell (WBC) count and differential is a crucial laboratory test for basic diagnostic practices. In this paper, we demonstrate proof of concept results for a disposable cartridge that could be used to perform a WBC count and 3-part differential at the point-of-care. The cartridge is composed of a glass slide, a layer of transfer tape, and a glass cover slip and incorporates acridine orange for cell staining and sub-type differentiation; the stained blood is then imaged, and image analysis techniques return a WBC count and 3-part differential. The cartridge was tested on a laboratory microscope with 3 normal samples, and had promising results with 85.7% of images resulting in a WBC count with ±15% of the true value. Further, the 3-part differential concentrations determined using the disposable cartridge had strong correlations with the true concentrations (R values of 0.9986, 0.9421, and 0.6942 for granulocytes, lymphocytes, and monocytes, respectively). Preliminary designs for a low-cost, portable microscope have been created and are currently being prototyped.