The Telegraph
Tuesday , July 22 , 2014
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Hopkins tool to fight female mortality

A palm-size box running on a phone app, devised by the largest medical institution in the US, holds the promise of reducing India’s female mortality through real-time tracking of anaemia among rural women.

The device comes with sensor clips, which when attached to fingertips extract signals that are analysed to compute the haemoglobin count in the individual’s blood. The count is displayed on the screen of a cell phone fitted to the device. The whole process takes just 30 seconds.

Johns Hopkins University, a prominent name in public health and known for “a lot of clinically relevant innovations”, has pioneered the device — named Haemoglobe — and partnered with an NGO in Calcutta for field tests.

Last week, a team comprising representatives of the university and the NGO, Foundation for Innovations in Health, camped in Usthi, South 24-Praganas, and tested the haemoglobin count of around 150 women with the device.

Steering the tests was Soumyadipta Acharya, the graduate programme director of the Center for Bioengineering Innovation and Design (CBID) at Johns Hopkins. Acharya has been running a programme in medical device innovation at the Baltimore university.

“We focus on low-cost innovations that can have an impact on big health challenges, especially in resource-constrained populations of the world. Among the challenges we aim to tackle are maternal and neonatal mortality and infectious diseases,” said Acharya.

“We realised over the past four years that if we want to have an impact on saving lives, we need to look at the conditions that go undetected. Maternal anaemia is one of the biggest contributors to mortality on the day of birth in India. According to WHO statistics, of all the babies that die on the day of their birth every year on this planet, half of them die in India.”

Asked what led Johns Hopkins to team up with the Foundation for Innovations in Health, Acharya said: “It is important to partner with communities and think about the delivery and deployment model. Because of the NGO’s fascinating work in primary health care at the grassroots level… outside of the government infrastructure, we decided to join hands with them.”

The CBID and the parent body of the Foundation for Innovations in Health had in 2013 signed an MoU for a five-year research partnership aimed at taking the innovation to a stage where the Haemoglobe can be rolled out for mass use, complete with user modules.

Together they have completed field studies among women in more than 20 villages of Salboni in West Midnapore, Barhra and Suri in Birbhum, and Usthi and Namkhana in South 24-Parganas.

Acharya, who went to Calcutta National Medical College and Hospital, pointed out that maternal mortality caused by anaemia “continues to be a vexing problem” despite the condition being “so easily treatable”.

“The motivation to take medicines for non-symptomatic conditions is very low. An anaemic woman may feel weak or dizzy but probably she has been feeling that way forever, so she does not react. Therefore, most of the women in areas that are socio-economically backward do not access antenatal services,” said Acharya.

The “lack of motivation” led to the thought of transforming an “invasive test” for anaemia into a low-cost, non-invasive one (that will not require drawing of a blood sample) for poor women. Haemoglobe is the outcome of the thought.

Community health workers or “the last mile foot soldiers” are currently the target users, who the team believes could deliver the low-cost life-saving test device on the doorstep of every woman in rural areas.

During the test the device is wired to a cell phone, on whose screen the haemoglobin count flashes after the 30-second test. “The cell phone, even the most basic one, is a fairly powerful computer which substantially reduces the cost of electronics and hardware,” said Acharya.

Another interesting aspect of the device is that the reading displayed on a cell phone screen is automatically sent to a central server, resulting in every case of anaemia being recorded on Google map.

“This is to help health administrators detect anaemia at a community level and maintain centralised surveillance,” said Acharya, hopeful that the innovation will replace five-yearly surveys with real-time data on anaemia.

“Colour-coded maps to depict mild, moderate and severe anaemia will help health workers counsel women better.”

At this point Haemoglobe is an invention in process. “What we have now is the third generation hand-manufactured prototype and we’re several months to a year away from the final product,” said Acharya. The data collected during the field tests are analysed real-time to check for accuracy and to further refine the system.

A team of 20 comprising students from the US, Australia, Canada, Thailand, Botswana, Kenya and India are involved in the Haemoglobe project in Tanzania, Kenya and South Asia. In India, besides Bengal, field tests are being carried out in Rajasthan, Chhattisgarh and southern states.

The Foundation for Innovations in Health, in partnership with the CBID, will open a large number of medical kiosks equipped with integrated diagnostic equipment (including a blood pressure monitor, electrocardiogram, and a pulse oximeter) across the state in a year. The Haemoglobe, once it is introduced on a mass scale, will be part of the integrated diagnostic device.

“The first kiosk was opened at Barhra on July 17. This will be followed by Mollarpur (Birbhum) and the Sunderbans,” said Satadal Saha, the vice-president of the NGO.

Only girls are being trained to run the kiosks. “Boys will find jobs and move out. We want to empower girls. So far we’ve trained 43 women in dispensing medicines and giving injections,” Saha, a general surgeon, said.

Actress Roopa Ganguly, a founding member and the secretary of the Foundation, attended all the field tests in Bengal and drew blood samples from women. (Conventional haemoglobin tests were also being done at the camps to test the accuracy of the Haemoglobe results).

“I have natural nursing instincts and learnt how to draw blood. Hopefully, I will learn to operate the Haemoglobe soon,” said Roopa.

“I’ve been friends with Satadal for many years and been watching their work from a distance. My job never allowed me the time to join them on the field. Now I don’t do more than two or three films in a year. I have a lot of time. Keeping the Foundation in mind, I’ve cut down on a lot of my screen work,” said Roopa, who also runs a shelter for children called Chhaya.

For the trial runs around Bengal, Roopa has been co-ordinating the camps and crises management. “I’m willing to run from pillar to post to make sure that this device and the kiosks, that promise a big change, are implemented at a public level,” she signed off.