Health­care in­no­va­tion in the global south

Financial Mirror (Cyprus) - - FRONT PAGE -

Chil­dren die from pre­ventable and treat­able con­di­tions like di­ar­rhea and pneu­mo­nia ev­ery day, with the de­vel­op­ing world ac­count­ing for the ma­jor­ity of vic­tims. The need to pro­duce in­no­va­tive and cost-ef­fec­tive so­lu­tions that can be de­liv­ered in re­source-de­prived set­tings could not be more ap­par­ent.

Con­sider pneu­mo­nia, deaths of chil­dren un­der chil­dren – each year.

A key com­po­nent of the treat­ment of hospitalised chil­dren with se­vere pneu­mo­nia is “bub­ble CPAP” (con­tin­u­ous pos­i­tive air­way pres­sure), in which a com­pres­sor de­liv­ers oxy­gen to the pa­tient, en­sur­ing a con­tin­u­ous flow of air dur­ing the treat­ment process.

In the de­vel­oped world, me­chan­i­cal ven­ti­la­tors pro­vide the re­s­pi­ra­tory sup­port of bub­ble CPAP. But me­chan­i­cal ven­ti­la­tors are far too ex­pen­sive for de­vel­op­ing-coun­try health sys­tems, leav­ing mil­lions of pa­tients in much of the Global South with­out ac­cess to life-sav­ing bub­ble CPAP. which ac­counts for 15% of all five years old – nearly a mil­lion

But with a com­bi­na­tion of med­i­cal ex­per­tise and in­ven­tive think­ing, Jobayer Chisti, my col­league at the health re­search or­gan­i­sa­tion icddr,b, has de­vel­oped a sim­ple and af­ford­able al­ter­na­tive to bub­ble CPAP us­ing ma­te­ri­als that are read­ily avail­able even in poor coun­tries, such as empty sham­poo bot­tles and plas­tic tub­ing.

Last year, Chisti and his team, in col­lab­o­ra­tion with col­leagues from Aus­tralia and with fund­ing from the Australian Agency for In­ter­na­tional De­vel­op­ment, con­ducted a clin­i­cal trial in Bangladesh to com­pare the ef­fi­cacy of this al­ter­na­tive ap­pa­ra­tus to the low- and high-flow oxy­gen ther­a­pies rec­om­mended by the World Health Or­gan­i­sa­tion in re­source-poor con­texts. The re­sults were in­spir­ing.

Bub­ble CPAP de­liv­ered with the ultra-low cost ap­pa­ra­tus was shown to be as ef­fec­tive as the stan­dard low- and high­flow oxy­gen ther­a­pies. In fact, just 4% of in­fants died when treated with the im­pro­vised bub­ble CPAP device, com­pared with 15% of those re­ceiv­ing low-flow oxy­gen therapy.

The case for fur­ther test­ing of Chisti’s al­ter­na­tive bub­ble CPAP de­liv­ery sys­tem – not to men­tion its im­ple­men­ta­tion in places where al­ter­na­tive treat­ments are not avail­able – is clear. If fu­ture tri­als demon­strate sim­i­lar high ef­fi­cacy, low­cost bub­ble CPAP could be­come the stan­dard of care for pneu­mo­nia in re­source-de­prived set­tings, po­ten­tially sav­ing thou­sands of lives ev­ery year.

But Chisti’s re­search has


far be­yond

the in­ven­tion it­self. It re­in­forces the idea, which has been a defin­ing mo­ti­va­tion of my own work lead­ing the Ma­ter­nal and Child Health Di­vi­sion at icddr,b, that in­no­va­tors liv­ing and work­ing in re­source-poor set­tings are among the best equipped to de­velop and test cost-ef­fec­tive health so­lu­tions. Af­ter all, no­body un­der­stands the lim­i­ta­tions of a weak health-care sys­tem bet­ter than some­one who has to work in one.

That is why glob­ally net­worked, de­vel­op­ing-coun­try-based health re­search in­sti­tutes like icddr,b are in­valu­able. They pro­vide a plat­form for lo­cal re­searchers and in­no­va­tors to recog­nise op­por­tu­ni­ties that an out­sider may never see, and to de­velop and eval­u­ate their ideas in the pre­cise en­vi­ron­ment for which they are de­signed.

With the data they col­lect, de­vel­op­ing-coun­try health-care in­no­va­tors can set the stage for their clin­i­cal ad­vances to be trans­formed into na­tional pub­lic poli­cies, not just in their own coun­tries, but in re­source-de­prived com­mu­ni­ties world­wide. The re­sults prom­ise to trans­form the lives of ne­glected and im­pov­er­ished peo­ple ev­ery­where.

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