Through observation of U-5 hospital clinics, outreach efforts and the pediatric ward as well as discourse with clinical officers/community health workers/nurses, I’ve attempted to understand how pediatric measurements – a central aspect of care for children – occur at St. Gabriel’s. I also hope to provide some background on the importance of anthropometrics, measurements of the body, and how Babymetrix could fit in the current framework of the hospital.

Brief Background on Babymetrix

Before proceeding to my observations and thoughts, I figured I’d provide some information on the technology. Babymetrix is a device that measures the height, weight and head circumference for babies from 0 to 2 years of age. While these measurements seem awfully simple to attain, this is not always the case in many developing countries. Often measuring practices are unsafe, unreliable and costly. For example, the current gold standard for height measurement in this target group is a length board, but the commercial cost of such a device is ~$300 to $500 (Babymetrix is under $40). Moreover, many have asked why such a device is needed when a simple tape measure could do the trick; however, studies have shown how unreliable and imprecise such a technique truly is. These values are vital in ensuring the health of babies and errors can lead to improper diagnosis/treatment. Finally, Babymetrix affords multiple additional advantages: integration, portability and simple manufacturing. Currently, there is no technology that provides all three forms of measurement in such a low-cost manner. In addition, the lightweight and foldable structure of the device can adapt to the traveling health worker. Lastly, the device’s material of wood and tarp can make it suitable for production in local areas.

Role of Anthropometrics

So the question naturally arises, why is important to have Babymetrix? Why are measurements necessary? First, malnutrition and the host of developmental/growth faltering (stunting, wasting, underweight, kwashiorkor, marasmus, failure-to-thrive, chronic vitamin/mineral deficiencies, etc.) impact an extremely large portion of children worldwide. In fact, thirty percent of the world’s children are considered stunted/underweight, with seventy percent found in developing countries. This statistic holds true in Malawi, where approximately 46 percent of children under five are stunted and 21 percent are underweight. Malnutrition has severe long-term consequences, such as irreversible, crippling damage to cognitive development and increased susceptibility to chronic diseases, which only intensify the vicious cycle of poverty. More proximately, malnutrition can predispose the child to pneumonia, diarrhea, malaria, etc. that can be deadly for such a young, unhealthy population. UNICEF cites that 50% of child death can be attributed to malnutrition. Measurements also play a dominant part in drug dosing for children, which requires accurate knowledge of the body’s surface area to prevent toxicity or insufficient amounts. Furthermore, measurements and growth faltering often signal underlying diseases, such as infections of parasitic worms, that could go otherwise unnoticed and lead to lasting damage. For the cases mentioned above, it has been deemed that interventions in the first 18 months of life provide the greatest benefit and later fixtures do not completely correct the harm. To this end, instilling a culture of measurement and providing a user-friendly, affordable tool can go a long way.

Measurement Practices at St. Gabriel’s and implications for Babymetrix

Having provided a small overview of the importance of anthropometrics and Babymetrix, I was extremely interested to observe the practices/methods firsthand at St. Gabriel’s. I came in expecting what my research told me, limited measurement instruments and an absence of focus on anthropometrics. However, I was surprised to see that this was simply not the case. They had a well-established organization and detailed record keeping/monitoring. Moreover, they had all the World Health Organization (WHO) charts useful for assessing nutrition/growth status.

• U-5 Outreach Clinics: Each Thursday, a group of community health workers/volunteers would travel to villages surrounding the hospital in a vehicle and set up prenatal and pediatric care. This included updating on vaccines, checking the health of the fetus as well as measuring the weight of the child. All of this information was written in booklets called Health Passports, which mothers carried around carefully, to ensure proper long-term care. I am truly impressed by how integrated health passports are in providing care.
• U-5 Hospital Clinics: Occurring each Friday, this clinic brings those pediatric patients deemed malnourished and continuously monitors their growth, in terms of height/weight and mid-upper arm circumference (MUC). The health workers particularly liked using this band, which was colored coded and easy to understand. Height was measured by a donated lengthboard and weight occurred through a food hanging scale mechanism. Weight measurement was particularly interesting, mothers used chichenyes, cloths formed into a “baby backpack”, to attach the infant to the hanging scale. This “backpack” is ALWAYS with them and is a culturally assimilated technique that was amazing to watch. Upon completion of measurements/record, mothers were provided nutritional supplements.

• Pediatric Ward: The emphasis here is on weight. There are various types of scales for this purpose and drug dosing occurs using this measurement.

I quickly realized that Babymetrix wouldn’t provide a revolutionary change to pediatric measurement practices at St. Gabriel’s Hospital. This finding posed the difficulty of working on a global health challenge from abroad and stressed how important it is to field-test/conduct site visitations to properly design. With that being said, there were some aspects in which Babymetrix can definitely be useful.

• Reliance on only weight measurement for outreach clinics is not optimal, as the belief that weight correlates with growth is often inaccurate. Weight is largely dependent on hydration status and fat mass and is thus, error prone. Babymetrix, with its integrative functions, can expand these criteria. Unfortunately, the real challenge would come in updating Health Passports, as presently there is only a graph for weight over time versus height over time.
• Weight measurement method used currently is not the safest. The baby is lifted multiple feet in the air and linked to a scale in a human-tied knot. I observed 5 or so almost falls in the ~50 patients weighed. Though two people, mother and health worker, are attentive, this process puts undue risk and discomfort on the baby. Babymetrix, which only requires a lifting of one/two inches, can address these issues.
• Would a Babymetrix one-stop station be quicker? This is something I want to explore as the process of measuring and recording utilized seemed pretty efficient. However, two Babymetrix devices could expedite this process.

The above observations were in contrast to what one of my teammates observed in a low-resource small hospital in India, which didn’t have established measurement processes, and could very likely clash with other rural hospitals/clinics/centers in Malawi. In both cases, the feedback came from a single hospital in the country and by itself cannot be universalized. For example, while the portability of Babymetrix was not as significant for St. Gabriel’s which provides vehicular transport for its health workers, it could mean the difference between use and disuse in settings where walking/biking is the primary method for outreach. This emphasizes the potential challenges in technology implementation; there is a need to find the proper niche for the technology, to create a culture/incentive where the technology is desired, provide a method to make it useful (record keeping, provision of nutritional supplements, etc.), etc. A device designed for a broad problem far away in another country cannot alone lead to implementation. The progression requires iterative communication and tailoring. With that being said, the on-the-ground experience has been essential in broadening my perspective and gaining valuable device feedback. So from this hospital begins the quest to continue improvements and more aggressively understand how Babymetrix can be effectively deployed in the field.

A Day in Blantyre

This past weekend, we took a coach bus from Lilongwe to Blantyre, to drop off various technologies and medical supplies to the other interns. Of course, it was great to see how they were living and experience the largest city in Malawi. Unlike Lilongwe, which has vast patches of green space, Blantyre felt like a much more cohesive city with building following building. We got a chance to go about a gigantic, maze-like market, which included an enormous vegetable/fruit section and countless clothing/technology/other random vendors. It was ridiculous. We concluded the day with some excellent Brinner (Breakfast-for-Dinner) that our fellow interns so graciously made. It was an overall great trip. Enjoy the pictures!