Placed on a hospital cupboard about two meters from the ground, the little box glows with a brilliant blue light, beautiful in the dark. Unlike the normal incubator used in Paediatric Intensive Care Units (PICU), the box measures approximately about 1m x 0.5m x1m (3ft x 2ft x 2ft) and weighs a little above 5 kilograms (11 pounds) . This box has saved the lives of many babies since a young mother and her team first produced it, three years ago.
Originally conceived, designed, tested and launched in Yenagoa, Bayelsa State, the box now sits in the paediatric units of various hospitals in the Federal Capital Territory (FCT), including Maitama, Wuse and Asokoro District Hospitals.
Named Crib A’Glow, it is a low-cost phototherapy solution to treat newborn babies with neonatal jaundice. It was developed by a young mum and professional graphic designer, Virtue Oboro, after her son’s experience with jaundice. With a group of medical professionals and biomedical engineers, she built a prototype, but it took four failed attempts and several trials before the product worked and she started her company, Tiny Hearts Technologies.
Addressing a Silent Child Killer
Data from the World Health Organization’s Global Health Observatory shows that in 2017, newborn deaths accounted for 47% of deaths among children under five, and in 2016, 1 million children died as a result of complications arising from premature births. While jaundice occurs in about 50% of babies reaching full term, it occurs in 80% of preterm babies. A paediatric specialist at the Asokoro District Hospital in the FCT estimates that 8 out of every 10 premature births in their unit have the condition.
Image credit: Nigeria Health Watch
Jaundice is usually caused by an excessive build-up of bilirubin, a substance made when the body routinely breaks down red blood cells. However, a newborn’s still-developing liver often cannot remove bilirubin quickly enough, causing an excess. Another predisposing factor is Rhesus (Rh) incompatibility between a mother and her baby. Although a small number of babies have different rhesus blood types from their mothers, these mismatches can lead to jaundice. Occurring in the first few days of life, the most notable symptom is a yellow colouration of the skin, which with time, is also observed in the whites of the eyes. While many mild cases do not require treatment, the common treatment for severe jaundice is phototherapy which involves placing the baby under a special type of light that helps break down the excess bilirubin.
A harrowing experience with jaundice
If the bilirubin isn’t broken down quickly enough, it can lead to death or severe disability. Early detection is therefore very important because the symptoms can be missed by new mothers. In the case of Oboro, she thought her son, Tonbra, “just had a fair complexion.” Oboro was discharged from the hospital about 48 hours after delivery, and it wasn’t until her mum, a nurse, came visiting that she realised the yellowish colour was unusual. Once they returned to the hospital, little Tonbra was diagnosed with jaundice. Oboro described the experience that followed the diagnosis as “harrowing“, as the excitement of the birth of her first son was replaced with fear and uncertainty, especially when she learned of the possibility of brain damage if the diagnosis was not properly handled.
With all phototherapy treatment units in use at the PICU of the hospital where Tonbra was admitted, a mother whose baby had almost recovered asked that her baby be discharged to give baby Tonbra a chance. Almost immediately, he was placed inside the phototherapy unit, but then, there was a power outage and other alternative sources of power in the hospital failed. The doctors performed an emergency blood transfusion which sustained him until he was able to access a phototherapy unit. After about a week, Oboro returned home with her baby but the experience was not to leave her for weeks.
Nurses at Wuse General Hospital search for space to place the Crib A’Glow phototherapy unit. Photo source: Tiny Hearts
Necessity usually leads to invention but for Oboro, it was a combination of the near-death experience of her son, curiosity, a passion for problem-solving and empathy for other babies who might face similar situations, that led to the development of Crib A’Glow.
Once she and her son had recovered from the experience, she set out to learn more about jaundice and possible ways for other parents and healthcare providers to overcome the challenges they had faced. The main problems turned out to be lack of quick access to treatment and unstable power supply.
After extensive research, Oboro and her team came up with Crib A’Glow, a simple solar-powered phototherapy system that can be easily moved around to locations where it is needed.
Powered by the sun, the unit solves the problem of unreliable power supply. It also improves ease of access as the equipment can be easily disassembled and moved from one location to another where it is needed urgently.
As a social enterprise, the company is sustained by selling and hiring out the Crib A’Glow phototherapy units. A unit sells for N150,000 and can be rented at the rate of N3000 for 24 hours. Tiny Hearts Technologies also produces disposable phototherapy blindfolds, conducts training programs and recently launched a sensitisation initiative called Yellow Alert to help raise awareness about neonatal jaundice among pregnant women.
Medical staff at the neonatal and pediatric unit in Asokoro District Hospital watch a demonstration of the Crib A’Glow phototherapy unit. Photo source: Tiny Hearts
Beyond Bayelsa: Scaling up a home-made solution
Since the inception of Tiny Heart Technologies in 2016, over 1250 babies have benefitted from their initiative, says Oboro. For her, the task of pitching their services to hospitals is a difficult process because most times, they are met with scepticism. “They usually prefer big equipment from big companies outside Nigeria and usually don’t want to try homemade solutions,” Oboro said. However, they continue inventing strategies to win them over. She recounted how such efforts saved a baby’s life and led to bringing the Crib A’Glow unit to three hospitals in the FCT.
In February 2018, Oboro walked into the paediatric intensive care unit of the Niger Delta University Teaching Hospital (NDUTH) in Yenagoa, Bayelsa state capital. Her mission was to retrieve the phototherapy unit she had rented to the hospital for use. An attending paediatrician told her that a baby was to start treatment with the unit, but the parents were unable to afford it. After hearing the story and with a plea from the doctor to assist, she decided to see the baby.
Medical staff at Wuse General Hospital receive a free unit of the Crib A’Glow phototherapy equipment from Tiny hearts technologies. Photo source: Tiny Hearts
Baby Ndukwe, as he was called, had jaundice but presented at the hospital when complications had set in. His parents had turned to herbal remedies when they first noticed he was sick. On seeing the state of the baby, Oboro decided to assist by starting a fundraiser for him even though it was out of their line of business. She got consent from the parents, took baby Ndukwe’s picture and asked for financial help through her WhatsApp network. Within 24 hours, over N70,000 was raised. This helped offset his medical bills, rent the phototherapy unit for the duration of his treatment and even covered the next baby in need of treatment.
Someone who donated to the fundraiser for baby Ndukwe bought three units of the phototherapy unit and anonymously donated them to three hospitals in Abuja. Oboro said the donor’s motivation was simple. “She said since the Crib A’Glow helped save the life of one baby, she wanted to extend that opportunity to other babies who might need it,” she said.
Twin babies placed inside a Crib A’Glow phototherapy unit in a private hospital in Bayelsa. Photo source: Tiny Hearts
Can Nigeria sustain innovative homegrown start ups?
The challenges with the Crib A’Glow solution are not different from other Nigerian start-ups and largely revolve around the cost of running a business, hiring and retaining talent, government support and regulations. But as a Nigerian medical equipment and device start-up, Tiny Hearts Technologies has its unique set of challenges too, one of which is the inherent preference for imported products. Oboro said this is one of their biggest challenges because it’s difficult to convince hospital executives to adopt their solution.
The cost of using the equipment is another challenge. Hospitals that rent the units need to make profit because they are running a business. This is likely to increase the cost for patients’ relatives and introduce a barrier to access. This can be overcome if there is an effective health insurance system that covers citizens in the formal and informal sectors.
The Crib A’Glow phototherapy unit was donated to Maitama District hospital by an anonymous donor after it saved a baby’s life in Bayelsa. Photo source: Tiny Hearts
A challenge which raises an important question is the issue of patents and protecting intellectual properties. How well are these innovations protected especially in a highly competitive market like Nigeria? Oboro says she has a patent right which offers protection for her design. The legal framework for patents is enshrined in the Patents and Designs Act of 1971. In place for nearly five decades now, is the Act still in tune with current realities, and able to protect young inventors?
Globally, there is a need for affordable technologies to tackle neonatal jaundice. The Crib A’Glow is one of such but for it to thrive, we must develop a culture of adopting and supporting Nigerian-made solutions once they are proven to be effective. The team has plans of expanding to other African countries but charity, they say, begins at home. Let us adopt and use our own, so that other babies like Tonbra and Ndukwe can be given a fighting chance.
By Chibuike Alagboso (Lead Writer)
Play Zuri Health launches its first mHealth App to help provide affordable and accessible healthcare solutions
Play Zuri Health Limited Mobile App (Source: Zuri Health)
Play Zuri Health Limited, a branch of the Play Communications Limited announced the launch of their first mobile app, Zuri Health; that can be downloaded from the Google Play Store, Apple Store as well as the Zuri Health website.
Zuri Health’s mission is to provide certified, affordable and accessible healthcare solutions via mobile with dedicated apps, wap and SMS services based on availability, location and specialization of the medical providers.
Users will have access to a myriad of professionals and services from across their home counties. They are able to book appointments instantly with any medical professional or hospital within their geographic regions, book laboratory tests, chat with the practitioners via both message and video as an added feature and request for home visits by the Licensed and Certified Medical Practitioners.
Under Pharmacy, users can get their prescription and over the counter medication online and have it delivered to their doorstep.
The SMS service functionality of Zuri Health has been designed to reach a wide range of individuals or users who may not have access to WAP or internet enabled devices.
The app’s code was written with the daily challenges patients face in the journey of seeking affordable and accessible healthcare solutions. We solve the problem of expensive and inconvenient hospital trips for small or minor diagnosis and prescriptions, long waiting times and queues during doctors’ visits and appointments scheduling and booking which can be tasking.
Through our mobile app, we also help doctors to tap into a wider market of on-demand patients and earn extra money while saving lives.
“Zuri Health App is very personal to me. Millions of people in Africa do not have access to quality medical care. At Zuri Health we have taken time to develop a product that will fill that gap, giving doctors a wider and easier platform to reach patients who need them. With Zuri Health the underserved populace can now access affordable and sustainable healthcare.” Arthur Ikechukwu Anoke- C.E.O and Co- Founder Zuri Health.
Daisy Isiaho Project Manager and Co-founder in an interview said, “In my view, there is an urgent need to drive more meaningful conversations in relation to frameworks around Telemedicine because in Africa very few countries have these yet its fundamental if we should achieve the Sustainable Development Goals.”
Since the beta launch in November 2020 the company’s predicted three year growth plan is to have more than 20,000 registered doctors listed, 250,000 premium users and at least 1,000,000 mobile downloads.
Live A Full Life With Sickle Cell Disease
Kunle Tometi a Pharmacist, Entrepreneur and Public Health Advocate.
The World Sickle Cell Day is a United Nation’s recognized day to raise awareness about sickle cell disease (SCD) at a national and international level. On 22nd December 2008, the UN General Assembly adopted a resolution that recognizes sickle cell disease as a public health issue and “one of the world’s foremost genetic diseases.” The resolution calls for UN member states to raise awareness about sickle cell on June 19th of each year.
In this article, I would be creating awareness on sickle cell disease, the causes, symptoms, treatment and prevention.
What is sickle cell disease (SCD)
Sickle cell anemia (sickle cell disease) is a disorder of the blood caused by inherited abnormal hemoglobin (the oxygen-carrying protein within the red blood cells). The abnormal hemoglobin causes distorted (sickled) red blood cells.
SCD is more common in certain ethnic groups, including:
- People of African descent,
- Including African-Americans (among whom 1 in 12 carries a sickle cell gene)
- Hispanic-Americans from Central and South America
- People of Middle Eastern, Asian, Indian, and Mediterranean descent
- Approximately 2000 infants are born annually with the disease
- SCD affects approximately 200,000 Americans annually
- 1 in 365 African Americans
- 1 in 13 African Americans have the traits (carrying only 1 of the gene, S)
(CDC August 2017, Mayo Clinic)
Economics of SCD
10 years ago; Medical expenditure for children with SCD averaged $12,000 yearly for those with Medicaid and $15,000 yearly for those with commercial insurance.
There were also 113,000 hospitalizations costing over $500,000 paid by Medicare and Medicaid of which 75% of the visits were in adults and each with at least 3 Emergency Room visits per year. Children with SCD miss a minimum of 18 days per school year
Total healthcare costs nowadays for SCD is estimated at $2billion per year.
According to (David A.N et al 2018), ‘In Nigeria, the prevalence of SCD is 20–30/1000 live births. The burden of the disease has reached a level where it contributes 9–16% to under-five mortality in many West African countries. Hemoglobinopathies alone represent a health burden comparable to that of communicable and other major diseases’
Causes of SCD
Healthy red blood cells are round, and they move freely through small blood vessels to carry oxygen to all parts of the body. In SCD, the red blood cells become hard and sticky and look like a C-shaped called a “sickle” and they are not able to carry enough oxygen. When they travel through small blood vessels, they get stuck and clog the blood flow.
The sites most often affected by clogging or stacking of sickle cells are found in the lungs, liver, muscle, bone, spleen, eyes, and kidneys and other parts and tissues of the body: explains why patients complain of a lot of pain in these areas as the symptom of the disease.
Patients also have immunity suppression which leads to infections by bacteria, and viruses.
Symptoms of SCD includes;
- Excessive fatigue, irritability from anemia
- Jaundice (yellowing of eyes and skin), may also include retina damage
- Swelling and pain in hands, and feet, Pain in chest, back arms and legs, also damage of hip
- Frequent infections,
- Pain and problems in the spleen, (Nausea, vomiting, diarrhea)
- Delayed growth
- Stroke (20–30% of children stroke, 23% in African Americans)
- Genitalia (priapism, a constant erection, in which severe episodes may lead to impotency)
Treatment of Sickle Cell Anemia
Treatment of SCD pain or crisis is done in the following manner:
Rehydration: with IV fluids, helps Red blood cells return to normal shape
- Antibiotics: used to treat underlying infections. In some cases antibiotic prophylaxis, penicillins are recommended.
- Pain medications to treat acute pain
- Hydroxyurea: helps increase production of red blood cells
Immunization: Pneumococcal and Meningococcal vaccines have drastically reduced the rate of infections in SCD
Blood transfusion: improves oxygen and nutrients needed
Supplemental oxygen by mask makes breathing easier and improves oxygen levels in the blood
Bone marrow transplant: for severe complications and matching donors.
- Genetic counselling and testing (better before marriage and at pregnancy) can help prevent the likelihood of passing gene to your child
- Preventing infections can be achieved by practising simple hand washing techniques at every opportunity. Hand sanitiser gels and wipes are also available and affordable
- Immunisation is very important and one must assure shots and records are current to cut down on the rate of common infections.
- Re-hydration with fluids at all times is essential.
- Avoid staying in places with low concentration of oxygen, e.g. unpressurised air planes, or high altitudes
For more information about SCD, please speak to your Pharmacist or Doctor.
Article by Kunle Tometi a Pharmacist, Entrepreneur and Public Health Advocate.
- Mayo clinic https://www.gstatic.com/healthricherkp/pdf/sickle-cell-anemia.pdf
- CDC https://www.cdc.gov/ncbddd/sicklecell/data.html
- Sickle cell Disease: Public health agenda & Social, Economic and Health implications by CDR Althea M Grant, PhD September 2012
- Overview of the management & prognosis of sickle cell disease, Joseph Palermo, D.O.
- Economic impact of sickle cell Hospitalization. R Singh, Ryan Jordan and Charin Hanlon
- Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria
Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria.
Adaku Efuribe: COVID-19 treatment and the dangers of drug misuse in Nigeria
Adaku Efuribe (Image credit: Adaku Efuribe)
Drug misuse is defined as the use of a substance for a purpose not consistent with legal or medical guidelines (WHO, 2006). It has a negative impact on health or functioning and may take the form of drug dependence, or be part of a wider spectrum of problematic or harmful behaviour (Department of Health, 2006).
At the moment there seems to be an increased risk of self-medication and drug misuse especially in countries where prescription only medicines could be bought without prescription. For instance, countries like Nigeria where some patent medicines dealers who are meant to sell GSL medicines end up dispensing pharmacy only medicines and prescription only medicines.
As soon as a new drug for managing COVID-19 is announced by mainstream media, people run off to the shops to buy these drugs, even people who have not tested positive for the coronavirus, indulge in self-medication in a bid to prevent contracting the virus.
I am worried about the recent announcement for Dexamethasone as a new drug for treating COVID 19. Information reaching me shows, following hours of announcing this drug by the media, some Nigerian resident has started trooping to their pharmacy, ‘chemist’ and illegal drug dealers to buy dexamethasone tablets.
Dexamethasone is a corticosteroid, it has high glucocorticoid activity, and it should not be used without the guidance of a clinician. According to the Electronic Medicines Compendium (EMC), depending on the dose and duration of therapy, adrenocortical insufficiency caused by glucocorticoid therapy can continue for several months and in individual cases more than a year after cessation of therapy.
Through immunosuppression, treatment with Dexamethasone can lead to an increased risk of bacterial, viral, parasitic, opportunistic and fungal infections. It can mask the symptoms of an existing or developing infection, thereby making a diagnosis more difficult. Latent infections, like tuberculosis or hepatitis B, can be reactivated.
Dexamethasone also has some side effects; the following side effects are common (occurring in greater than 30%) for patients taking dexamethasone:
· Increased appetite.
· Difficulty sleeping (insomnia)
· Swelling in your ankles and feet (fluid retention)
· Muscle weakness.
· Impaired wound healing.
· Increased blood sugar levels
If only the media companies understood the fact that prescription only medicines could be bought without prescription in some countries, they would thread carefully and choose appropriate wording when announcing potential drugs for COVID-19 treatment.
It’s the duty of the Ministry of health and drug regulatory bodies of those countries where prescription medication could be bought in the market like sweets to continue to create awareness, educate the general public on the dangers of self-medication, drug misuse and drug abuse. They must not relent in their efforts of managing drug distribution/regulation.
My advice to people living in countries where you could buy prescription only medicines without prescription is this:
Do not run off to buy the latest drug announced for COVID-19 treatment.
This drug is a corticosteroid and should only be taken if prescribed by a clinician.
Please do not indulge in medication misuse and abuse. It could lead to adverse effects or even death
Author: Adaku Efuribe is a Clinical Pharmacist & Global consultant in Medicines Management