Every year, though, 115,000 of those women die in childbirth from anemia-related problems. More than 600,000 infants do the same.
"We've known for a long time that maternal anemia is one of the great causes of death in mothers and newborns," said Wendy Taylor, director of the Center for Accelerating Impact and Innovation at the U.S. Agency for International Development, or USAID. "We've tried many different approaches. We just haven't been able to tackle it."
Enter Soumyadipta Acharya, an engineering professor at the Johns Hopkins University, and the team of undergraduates he has been working with for about a year. They've created a device weighing less than four ounces that could turn the problem on its head.
The creation, HemoGlobe, uses the computing power of a cellphone to enable health workers in the field to screen for anemia, an advance that could save millions of lives.
The idea won a $250,000 grant earlier this year at Saving Lives at Birth, an international competition for proposals in global health.
HemoGlobe "looks like a low-cost, easy-to-use, non-invasive device that can pick up anemia early and get the data back [into the global-health] system," Taylor said. "It could be transformational."
The idea was born in the Center for Bioengineering Innovation and Design, a joint department of the university's engineering and medical schools. Founded in 2007, the center encourages students to identify unmet clinical needs, then to create technologies to address them and draw on Hopkins' contacts in commerce and industry to get their inventions to market.
"The students always amaze me with their outside-the-box thinking," said Acharya, an M.D. and biomedical engineer who directs the center's graduate program.
For many inventions, the process begins when a few biomedical engineering students and educators travel to Africa and Asia every year to pinpoint health issues and study the ways health care workers are dealing with them. They return with a list of potentially fruitful projects, and the list makes its way, among other places, to "design team," an undergraduate course Acharya teaches.
The maternal-anemia epidemic drew the attention of Noah Greenbaum, a double major in biomedical and electrical engineering, now a senior, and five peers, including George Chen of Hacienda Heights, Calif., a sophomore.
Medical science knows how to treat anemia, a condition marked by low levels of hemoglobin in the blood. Hemoglobin, an iron-containing protein in red blood cells, carries oxygen throughout the body.
The disorder is barely an issue in the United States, where nearly 100 percent of pregnant women have access to clinics or hospitals for screening. In the developing world, that number hovers around 40 percent or 50 percent, which means many women will never know that iron supplements, intravenous iron treatments, or (in severe cases) blood transfusions could make them well.
"Many problems around maternal and newborn mortality occur in the hardest-to-reach communities in the world, in places lacking basic health infrastructure," Taylor said. "Our ability to screen at the community level is poor and unreliable."
Greenbaum and his team, led by Acharya, took up that challenge. "We settled on creating a low-cost anemia diagnostic," Greenbaum said. And so began a process of creative reasoning.
First, Acharya said, the team needed a "non-invasive" approach — one that would not include the expensive step of drawing blood.
"We wanted to create a screening test, not a diagnostic test," said Greenbaum, a native of Watchung, N.J. "We really wanted to be able answer one basic question: 'Does this woman need to go to the hospital or not?' "
They opted for an affordable form of pulse oximetry, a technique by which hemoglobin levels can be read by shining light through parts of the body.
Earlier Hopkins teams in Kenya, Tanzania, Nepal and India, meanwhile, had two key observations: Nearly every village was served by a community health worker, and nearly every one of those workers had a cellphone.
The team realized the computing power of those phones was enough to translate the hemoglobin readings into color graphics — green for mild anemia, yellow for moderate, red for severe. Members then wrote a program, built a circuit board to process the signals and encased the whole in a tiny unit the health worker can plug into any cellphone.
The device, HemoGlobe, has one more attraction: The cellphones can transmit results to a central server, where public health workers can potentially monitor anemia levels, even creating digital maps displaying those results by geographical location.
Early this year, the team entered HemoGlobe in Saving Lives at Birth, a competition sponsored by the Bill and Melinda Gates Foundation, the World Bank and other organizations.
More than 500 teams from 60 nations, including groups from UNICEF, the RAND Corp. and Oxford University, submitted entries. Last July, the HemoGlobe group became one of 15 grant winners, sharing the windfall with its public health partner, Jhipiego, a Hopkins-affiliated nonprofit.
The team said much remains to be done. Hopkins has applied for a provisional patent on HemoGlobe, but graduate students are still refining the engineering. Jhpiego is schooling the team on integrating the device into developing nations' health care systems. The team expects prototypes to be ready for field testing next summer.
Acharya hopes HemoGlobe will be available on the open market within about two years and is aiming for a price tag of less than $35, the current cost of a prototype.
At that price, Taylor says, the device could be mass-produced and used in many nations. "That's what we're looking for in our field these days — [projects with] scale and sustainability," she says. "HemoGlobe could have a big impact."