According to a study published earlier this year, 4.1% of the Indian population – about 50 million people – was in a state of “hidden poverty due to medical expenses” in 2011.
In a country where affordability deters access to healthcare, there is an urgent need to develop high-quality, easy-to-use, scalable and affordable technologies that solve problems in screening, diagnostics and therapy. These solutions will have to be devised by people at the primary healthcare level because secondary and tertiary care are more expensive.
Researchers at IIT Kharagpur recently pitched one such solution.
India bears one of the world’s biggest national burdens of anaemia. According to the 2018 Global Nutrition Report, almost 52% of women of reproductive age but who weren’t pregnant and 50% of pregnant women were anaemic. Anaemia precipitates organ damage by lowering the amount of oxygen in the body and contributes to multiple problems during pregnancy. These then culminate in pre- and post-natal maternal mortality.
Suman Chakraborty, a member of the department of mechanical engineering at IIT Kharagpur and the dean of sponsored research and industrial consultancy, and his students have attempted to build a low-cost, minimally invasive and portable device to measure haemoglobin levels.
Also read: Health Care Is an Essential Human Right – and so Is a Proper Diagnosis
Through a series of chemical reactions, haemoglobin helps break down hydrogen peroxide to produce oxygen. According to its design, the device triggers just these reasons to produce oxygen, which is made to react with o-toluidine to produce a bluish green substance. This substance absorbs light proportionally to its amount, so the more there is, the darker it will appear. Using this indicator, its makers say the device can estimate the amount of haemoglobin in the blood.
While this technique is not new to biochemistry, the device’s makers say its fabrication is novel. “We have printed micro-channels on a filter paper using a simple office printer, which guides the collected blood sample to pre-designated reaction chambers containing the reagents,” Chakraborty said.
Additionally, the device is expected to be able to interpret data from the bluish green substance through an app that can be installed on a smartphone – instead of resorting to larger, more expensive light-measuring devices.
The team figures as a result that each blood test could cost just Re 1. The device also apparently requires only a small amount of blood for each test.
Amitabha Ghosh, an honorary distinguished professor at the Indian Institute of Engineering Science and Technology, Shibpur, and a former director of IIT Kharagpur, said, “The functioning of the device is as simple as can be, hence it addresses the issue of both cost and convenience.”
As for how the device compares to others like it, Chakraborty said it will be “affordable for the masses and that is our flagship. We are currently trying to improve the stability of the reagents outside laboratory conditions and increase the rapidity of each reading.” He also noted that the device’s accuracy has room for improvement.
He further said his team is currently working with enterprises ranging from very small to medium to introduce the device among patients.
That said, a device like this is only as good as its ability to go from the lab to the market. There are two ways to do this: by identifying and collaborating with agencies that have access to the target population, and by optimising the technology to work in uncontrolled environments.
“We have conducted validation studies in three distinct stages,” Chakraborty explained. “For the first stage, we have taken blood samples from the in-house hospital in IIT Kharagpur and compared our measured haemoglobin levels to the gold-standard test used in pathological laboratories, known as Drabkin’s method.”
They conducted their second study at the Salboni Superspeciality Hospital in West Midnapore district of West Bengal. The team said the results proved that the device worked in uncontrolled temperature and humidity conditions.
Chakraborty collaborated with the Foundation for Innovations in Health (FIH), a non-profit organisation in Kolkata, for the third study: to assess the feasibility of using the device in extreme point-of-care.
FIH has established an e-health delivery model in multiple health kiosks in rural Bengal. e-Health is the use of ICT in health, and it aims to improve access to affordable healthcare among different socioeconomic groups.
Also read: A ‘New Era’ in the Treatment of Type 2 Diabetes? Not Yet
“For us, the collaboration was a natural symbiosis,” Satadal Saha, a visiting professor at the school of medical science and technology at IIT Kharagpur and vice-president of FIH, said. “Prof Chakraborty has provided us with the technological expertise for affordable healthcare [and] we have provided our market access, trained rural health professionals and primary infrastructure.”
Saha also said the third study helped identify “need and boundary conditions of the rural environment” and that they were using the data thus obtained to improve the device and the workflow associated with it.
The FIH conducted the test at a health kiosk in Barhra, a village in the state’s Birbhum district. Health workers collected blood samples from 60 people and the results were compared to those a HemoCue haemoglobin analyser, a commercial product considered to the industry’s gold standard for on-field use, yielded.
Royina Saha, a programme officer at FIH and a postgraduate student at King’s College London who supervised the test, said, “Apart from high cost, irregular electricity and complex consumable requirements deter the large-scale acceptance of the gold-standard test for on-field use. Chakraborty’s device tries to circumvent both and can be operated with minimal training.”
The results from these studies are being compiled for approval from the Bureau of Indian Standards, after which it is expected to become available for commercial use. The group has also applied for a patent, as a result of which the results aren’t being publicised yet.
It also remains to be seen how human factors like acceptance in the healthcare fraternity, end-user trust, social influence and behavioural intention will impact the device’s large-scale use.
Sangya Chatterjee is a final-year graduate student pursuing a master’s degree in chemical and molecular biology at IIT Kharagpur.