A Reliable Innovation providing respiratory support to children…
“Some of the best indicators of a country developing along the right lines are healthy mothers giving birth to healthy children who are assured of good care and a sound education that will enable them to face the challenges of a changing world” — Aung San Suu Kyi
Every person on this planet may have heard about how important children are for a nation. They are often referred to as a Nation’s Future; and National Centre for Biotechnology Information, NCBI says, “Children’s Health — The Nation’s Wealth”.
In India, an estimated 26 millions of children are born every year. As per Census 2011, the share of children (0–6 years) accounts for 13 percent of the total population in the Country. The child health programme under the National Health Mission (NHM) comprehensively integrates interventions that improve child survival and addresses factors contributing to infant and under-five mortality.
In recent years, there has been an increased focus on issues that affect children and on improving their health. The global under-five mortality rate declined by 58 percent; from 93 deaths per 1,000 live births in 1990 to 39 in 2017. Despite the global progress in reducing child mortality over the past few decades, an estimated 5.4 million children under age 5 died in 2017.
Respiratory distress is a common presenting feature among newborn infants. The stark reality is that each year, 4 million people die prematurely from chronic respiratory disease. Infants and young children are particularly susceptible. A total of 9 million children less than 5 years old die annually, and pneumonia is the world’s leading killer of these children. In 2017 alone, roughly 15,000 under-five deaths occurred every day, an intolerably high number of largely preventable child deaths. Ending preventable child deaths worldwide will require targeted interventions to the age-specific causes of death among children and young adolescents.
We are in the process of alleviating the hustle of respiratory support need incurred by low-resource settings across the developing nation. Assessment of the current respiratory support capabilities for children with hypoxemia and respiratory failure in different economic settings has displayed Low and Middle Income Countries’ ICUs (Intensive Care Units) appearing to have the higher patient to medical staff ratios, with decreased patient monitoring frequencies. Treatments for infants with prolonged breathing difficulty include oxygen therapy, exogenous surfactant, various modes of respiratory support, and postnatal corticosteroids. Oxygen therapy must be more widely available; in many remote settings, this can be achieved by the use of oxygen concentrators, which can run on regular or alternative sources of power. In rural hospitals of developing countries, oxygen supplies are poor and detection of hypoxemia is difficult. Oxygen concentrators and pulse oximeters might help to manage the disease; however, the use of such technology in developing countries needs comprehensive assessment.
Talking about India, since independence, the country has created a vast public health infrastructure of Sub-centres, Public Health Centres (PHCs) and Community Health Centres (CHCs). There is also a large cadre of health care providers (Auxiliary Nurse Midwives, Male Health workers, Lady Health Visitors, and Health Assistant Male). Yet, this vast infrastructure is able to cater to only 20% of the population, while 80% of healthcare needs are still being provided by the private sector. According to the “Report on medical certification of cause of death 2015”, under the third leading group “Diseases of Respiratory System”, Pneumonia, caused 21.1 percent deaths, followed by Asthma causing 8.8 percent deaths. Pneumonia alone accounts for 1.9 percent of the total medically certified death. Out of the total medically certified deaths, around 8.4 percent has been reported for the infants (children who could not complete their first birthday); out of which, Diseases of Respiratory system was responsible for 5.2 percent deaths. Under this major group Pneumonia alone accounted for 2.4 percent deaths.
Clinical pneumonia (defined as respiratory infections associated with clinical signs of pneumonia, principally pneumonia, and bronchiolitis) in children under five years of age is the leading cause of childhood mortality in the world. Preterm birth rates are rising, and many preterm infants have breathing difficulty after birth. Eighty-one percent of deaths due to pneumonia occur in the first two years of life. The under-five mortality rate is higher in rural areas than in urban areas (56 deaths per 1,000 live births versus 34 deaths per 1,000 live births). In 2010, there were 120 million episodes of pneumonia (14 million of which progressed to severe episodes) in children younger than 5 years. In 2011, 1·3 million of pneumonia led to death. Hypoxemia (insufficient oxygen in the blood) is the major fatal complication of pneumonia, increasing the risk for death many times. It is estimated that at least 13.3 percent of children with pneumonia have hypoxemia, corresponding to 1.86 million cases of hypoxemic pneumonia each year. Despite its importance in virtually all types of acute severe illness, hypoxemia is often not well recognized or managed in settings where resources are limited. Oxygen treatment remains an inaccessible luxury for a large proportion of severely ill children admitted to hospitals in developing countries. Although considerably less expensive than in economically developed countries, intensive care in India and in other developing countries remains expensive relative to the cost of living.
Considering the gaps between availability and accessibility of the healthcare facilities and amenities, Biodesign Innovation Labs has come up with a solution for the high cost of continuous positive airway pressure, — RESPAP. ResPAP is a bubble continuous positive airway pressure based oxygen therapy solution that has been proposed as a treatment modality for children less than 5 years of age, who are suffering from mild to severe pneumonia and other respiratory distress conditions. We have developed a promising low-cost oxygen therapy solution device, which can be used to deliver supplemental oxygen or increased airflow to a patient or person in need of respiratory help. Along with the ultimate reduction in Under 5 mortality and morbidity rate, better treatments for low-resource settings where expensive technologies are not available; more efficiency in the treatment procedure; wider applicability as a result of low cost and ease of use; the outreach of the device; and a decrease in hospitals’ logistics are the expected outcomes of this device.
In children of age, 5 to 58 months with mild to severe pneumonia, bubble CPAP is more effective than standard low-flow oxygen therapy to reduce treatment failure in children with severe pneumonia. It will work towards reducing the Infant Mortality Rate and Under 5 Mortality Rate as per the Child Health programme under the Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH+A) Strategy of the National Health Mission (NHM). It will work towards the NRHM missions like universal access to integrated comprehensive public health services.
‘Jugaad Frugal Methods’ like making use of Saline bottle/Shampoo bottle to provide bubble CPAP for children have been widely appreciated across the developing countries. On the other hand, we have produced ResPAP; though it is an affordable product, we assure the reliability as it is a standardized medical device, which is definitely going to improve the quality of respiratory support, or else in providing additional respiratory support in hospitals that do not have mechanical ventilators or standard CPAP machines, that, especially in low-resource settings.