A simple tool and mobile phone application to improve community-based case management of premature and jaundiced newborns

The Brigham and Women's Hospital
Organization Location: 
Boston, MA, USA

We aim to develop and validate simple, low-cost, low-technology tools to improve community-based identification, referral, and care of premature and jaundiced newborns by frontline health workers. In our current seed grant, we designed a simple prematurity scorecard for community health workers (CHWs) to assess for prematurity, developed a training program, and will soon complete a validation study enrolling 1,000 pregnancies in Sylhet, Bangladesh. CHWs conducted the maturity assessment with high levels of agreement with physicians. In preliminary analysis, foot length measurement is a promising screening tool for prematurity. We are now seeking additional seed funding to further expand the CHW’s toolkit by: 1) developing a mobile phone application for a comprehensive newborn assessment to identify and manage premature infants, and 2) designing and validating a simple “jaundice ruler” (icterometer) to improve the accuracy of risk screening for severe hyperbilirubinemia, in both term and preterm infants. The low-cost icterometer ($0.50) will be made from digitally standardized, archival-quality paper color strips of increasing yellow hue affixed to the same transparent plastic ruler which is used to measure foot length. These tools will empower CHWs to more accurately recognize and refer sick, premature, and jaundiced newborns, improve access to effective treatment, and reduce neonatal morbidity and mortality in the highest burden settings. Integrated management of childhood illness does not currently include algorithms to identify or manage premature infants. Visual assessment of jaundice is subjective and challenging in darker skinned infants, and icterometers have previously been expensive, difficult to procure and use.

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