Babies in rural areas are most at risk of death, but technology can lead the way

Victoria Michael (38) visits a clinic run by the Norwegian People’s Aid. Victoria receives a bednet and her baby is vaccinated, South Sudan (Credit: Arne Hoel / World Bank).

The first few days after a baby is born are the most difficult for a mother and her child, especially in poorer countries. Without access to quality care, a mother and her new-born face a risky period which will shape a child’s future, leaving it vulnerable to preventable diseases and even death.

Over the past few decades, the global mortality rate for new-born children has dramatically reduced by around half. In 1990, over 5 million children died within the first 28 days: that number is now under 3 million, according to Unicef. Worryingly, of the children that die before they reach their fifth birthday, 46 per cent of these are within the first 28 days of life.

In low-resource settings in rural areas, where health systems are weak, women often lack access to the tools which can save their child’s life, even though the tools need exist widely elsewhere.

“Most deaths of children under five are caused by diseases that are readily preventable or treatable with proven, cost-effective interventions,” Unicef argues. However, often this technology is either too expensive or not suited to the needs of the local community.

As many children in rural areas are born outside of hospitals, mothers often don’t get the health education they need to look after their children, causing babies to die of preventable diseases.

Saving Lives at Birth, a USAID challenge fund, supports health innovators that focus on ending preventable diseases that claim that lives of many new-born children.

Approaches are light touch and focus on bringing practical solutions to rural areas. We focus on three projects: Bilihut, a project that tackles jaundice by bringing hospital facilities into the home; Bempu, which uses a bracelet on a baby’s arm to detect the onset of hypothermia; and Pratt Pouch, a foil package solution that brings antiretroviral drugs into the community.

Bilihut by Little Sparrows

80 per cent of prematurely born babies, their livers still underdeveloped after birth, suffer from jaundice — a build-up of blood pigment that turns their eyes and skin yellow. If untreated, it can cause brain damage and even death.

In the U.S. a baby is simply taken to hospital and receives phototherapy — or light therapy — in an incubator for 48 hours to help the liver break down bilirubin, which causes jaundice. Phototherapy isn’t widely available in rural areas however, where electricity is unreliable and clinics don’t have the right tools to deal with the condition.

“Parents have to travel quite the distance to an urban center to receive phototherapy treatment for their babies,” Donna Brezinksi, a paediatrician at Boston Children’s Hospitals, told Humanosphere. “This makes babies in these remote areas more susceptible to jaundice and its complications.”

To solve the problem, Brezinski founded Little Sparrows, a social enterprise behind Bili-Hut, a battery-powered device which brings phototherapy treatment out of the clinic and into homes.

The Bili-Hut approach is simple: take all the components inside a phototherapy device and retrofit the parts to use in a smaller, more portable device that can last a month once charged.

A baby receives phototherapy treatment inside a Bili-Hut device (Credit: Gary E. Gilbert, MD).

“The project literally started at my kitchen table. I created the first Bili-Hut prototype by ordering parts off the Internet and building it in my own home”, Brezinski said.

So far, Little Sparrows is working on pilots Cambodia, and has already seen its “biggest success” working in Kibuye in rural Burundi, according to Brezinski.

“The resources are incredibly scarce there, so to be able to provide the same efficacy in the treatment of jaundice in Burundi that we provide in the U.S. is a huge success for us. We were able to do that because of the unique capabilities of the Bili-Hut.”

Off the back of success in Burundi, Brezinski hopes to drive Bili-Hut into other markets where jaundice affects new-born babies.

“We foresee a significant market for the Bili-Hut in developing countries, and that in part, should subsidize our global health mission and give us more time to introduce Bili-Hut into emerging markets.”

The Bempu bracelet

Hypothermia, a condition where the body cannot regulate temperature, is among the top causes of new-born deaths and illness. According to WHO, it is estimated that 99 per cent of the 4 million children globally who die every year as a result of secondary illnesses caused by hypothermia live in low-resourced areas.

Compared to other illnesses, it is often an underappreciated major challenge to new-born survival in developing countries. Though it is rarely a direct cause of death, further complications, including infection and death, can occur if babies go untreated.

A lack of understanding about the importance of protecting babies against hypothermia is costing lives.

“Hypothermia is a silent killer, and a lot of parents are uneducated when it comes to hypothermia and they weren’t able to monitor their new-born’s temperature when they were at home,” Gini Morgan, public health and partnerships manager at Bempu, told Humanosphere.

Bempu is a social enterprise which started in India over two years ago. The solution is simple: a new-born child is given a bracelet which beeps if a baby’s temperature falls below normal levels, allowing the mother to take measures to regulate her child’s temperature at home. It is simple and easy to understand, Morgan said.

A mother uses the Bempu device to monitor her child’s temperature (Credit: Chris Witschy — Instagram).

“Coming up with a device that was intuitive and was very easy for parents with low levels of literacy to understand. I think was what attracted doctors the most to this device.”

Since Bempu launched it has expanded its reach to over 200 health centers in India and is now on the market in four African countries with plans to expand into other developing countries.

“With the bracelet, we really see it going to developing countries where there are high-risk babies most vulnerable from hypothermia. Being able to have a Bempu bracelet on every baby is definitely where we see ourselves in the next ten years”, Morgan said.

Pratt Pouch

According to Unicef, mother-to-child transmission accounts for over 90 per cent of new HIV infections in children in sub-Saharan African countries. However, in recent years, WHO says that new cases of HIV infection among children has reduced by around 60 per cent, thanks to antiretroviral drugs. This means that a mother is under 5 per cent likely of transmitting the disease.

The drug must be given to the child within the first 72 hours of life to decrease chances of transmission. Sub-Saharan African countries have the antiretroviral drugs available, but a large number of mothers give birth at home and are not given the drugs they need to treat their children immediately.

Antiretroviral drugs quickly lose their potency when put into a syringe, making it impossible to bring the drug to mothers in rural areas. This leaves millions of new-borns at risk of becoming HIV-positive either quickly after birth or during breastfeeding.

To tackle the problem, Bob Malkin and his students at Duke University in North Carolina invented Pratt Pouch, a foil package which prolongs the life of antiretroviral drug nevirapine to 12 months. The drug can then be delivered to local clinics during antenatal visits or by community health workers and nurses during outreach programs, where mothers can orally take the drug.

A baby is given antiretroviral drugs at home (Credit: Marc Gregor)

Malkin, who directs the program, said that the project has significantly increased the number of babies treated with drugs in hard-to-reach areas of rural Zambia.

“The year before we entered the community that we were working with, 34 per cent of the children who were born to HIV-positive mothers weren’t treated with antiretroviral drugs within the first three days of life. After we introduced the pouch, over 90 per cent of the kids in the very same communities were treated with the drugs.”

“So you’re talking about a huge change in the probability that those kids are going to be HIV-positive”, Malkin said. “That’s a huge, huge improvement.”

However, HIV is often a highly stigmatized disease within the community. Malkin adds that it is often difficult for a mother to declare that she is HIV-positive.

“In order to participate in our program, you have to be pregnant and HIV-positive, and that really requires that the woman is open about her status”, Malkin said.

Malkin, who suggests that mothers are often “very protective of their children” and don’t want their children to become HIV-positive, take the drug despite being “heavily stigmatized for being HIV-positive in their own lives.”