Thursday, April 24, 2014

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Heart-Warming Innovation Saves Mbale's Newborns

In areas where electricity is unreliable or equipment is scarce, low-cost infant warmers could help keep low-weight newborns alive.
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A low birth weight baby being kept warm by the BabyWrap. Photograph by Jon Shup.

Mbale, Uganda:

Adonno’s baby, Sylvia, weighed just 1.5 kg (3.3 pounds) when she was delivered by midwives at Mbale Regional Referral Hospital in eastern Uganda. At that low weight, she was born without the fat necessary to regulate her body temperature, which soon dipped.

Without external warmth, she would die within hours. But there was no working incubator at the hospital. The one in the maternity operating theatre was broken, used only as a table for newborn resuscitation, and the one in the Labour & Delivery ward gave off almost no heat.

Sylvia was just one of an estimated 20 million infants of low birth weight (less than 2.5 kg) born every year, 96% of which are born in developing countries. And she was at high risk of becoming one of the estimated four million infants each year who die before 27 days.

A warm embrace

Fortunately for Sylvia and Adonno, however, the hospital in Mbale is, as one paediatrician put it, “embracing Embrace”. That is to say, the hospital has begun using the Embrace BabyWrap, a low-cost infant warmer designed specifically for low-resource settings where the electric grid cannot be relied on. The device is a sky-blue, insulated pouch that is able to keep a low birth-weight baby at the perfect temperature – 37 degrees Celsius – for up to six hours at a time.

It does so using the WarmPak, an innovative pouch of wax-like phase change material that absorbs heat quickly and then releases it over a long period of time. It’s warmed in a heater for 25 minutes then inserted into the back of the BabyWrap, where it gives off heat to warm the infant – with no electricity required.

Embrace Global is the non-profit organisation behind the BabyWrap and the rest of the ‘Embrace Programme’, which includes education on neonatal hypothermia and Kangaroo Mother Care, a technique whereby low weight babies are strapped to their mothers to keep them warm and help the bonding process; robust monitoring and evaluation to understand the programme’s effect; and working with community members to provide locally-relevant complementary health education.

Brie Stewart, Embrace Global’s Programme Associate, says that this holistic approach is part of what sets the Embrace Programme apart: “Ultimately, we utilise the Embrace infant warmer as a vehicle to introduce health interventions for low birth-weight and premature infants – simply donating the infant warmers is not enough. To have a real, substantial, and sustainable impact, we implement holistic programming by providing access not only to the device, but also work to create awareness; offer continued training, education and support; and collect data to better understand our effect on maternal and child health.”

Originally developed by a multi-disciplinary group of graduate students at Stanford University’s Institute of Design in California, US, the Embrace Programme has been implemented in nine countries including India, South Sudan, China, Guatemala, Afghanistan, and Uganda. Programmes are partly funded by Embrace Global’s sister organisation, a for-profit, which sells the devices to hospitals in India – because Embrace Global owns the intellectual property, royalties from sales can be redirected into their programmes worldwide. This model helps to sustain the non-profit aspects of the organisation and prevents Embrace Global from being wholly reliant on aid.

Mbale Regional Referral Hospital is Embrace Global’s third pilot project site in Uganda, following successful implementations at Mulago Hospital in Kampala and the Teso Safe Motherhood Project in Soroti. Currently, there are six BabyWraps at Mbale Regional Referral Hospital which should be enough to keep all of the low birth-weight babies born at the hospital warm. Sister Jessica, who is in charge of the Acute Paediatric Unit, remarked, “The Embrace Programme is very helpful. The babies come in shivering and cold, but the warmers stabilise their temperature and help them get pink.”

Spreading the warmth

If the programme is a success at the hospital, there are many opportunities for expansion within the region. The ‘warm chain’ could also be extended beyond the hospital setting by improving transport between Health Centre IVs and Mbale Regional Referral Hospital, or BabyWraps could be placed in other health centres which have inconsistent electricity.

In the next year, Embrace Global hopes to expand its programme all the way to the village, using a WarmPak that can be heated in boiling water – avoiding the need for electricity altogether. Additionally, the organisation is hoping that in the future, a village-focused Embrace programme can help significantly reduce neonatal hypothermia, morbidity, and mortality across Uganda, other parts of sub-Saharan Africa, and eventually anywhere low birth-weight infants may be born.

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