Shampoo bottle saving infants’ lives from pneumonia

 

Created by: International Centre for Diarrhoeal Disease Research, Bangladesh

Presentation written by: Sadequa Sultana, sadequa.sultana@yahoo.com

Presentation supervised by: Assoc. Prof. Dr. Elena M. Barbu, elena.barbu@univ-grenoble-alpes.fr

Introduction

International Centre for Diarrhoeal Disease Research (ICDDR), Bangladesh is one of the world’s leading global health research institutes working with international collaborations for more than 50 years. Established in 1960 and located in Mohakhali, Dhaka 1212, Bangladesh. The Institute is committed to solving public health problems facing low- and middle-income countries through innovative scientific research; including laboratory-based, clinical, epidemiological, vaccine development and health systems research. By developing, testing and assessing the implementation of innovations specifically designed for resource-poor settings, it aims to improve the health and wellbeing of people living in the world’s poorest nations.

Government of Bangladesh provides its long-term financial support. Other core international grants are from- Bill & Melinda Gates Foundation USA, UKAID, USAID, NIH (USA), Sweden (SIDA), Global Affairs Canada, European Commission, etc. The executive director is John D. Clemens, MD. Ultimate responsibility for icddr,b governance lies with their “Board of Trustees” (17 members nominated by the Government of Bangladesh, WHO and UNICEF). icddr,b has a mix of national and international staffs working on 7 research themes including 144 permanent researchers.

The centre has many significant innovations including “the discovery and implementation of oral rehydration therapy” for the treatment of diarrhoea and cholera. This oral rehydration therapy is thought to have saved over 50 million people worldwide. Other major innovations are: Zinc Treatment for Diarrhoea, Tetunus Toxoid Vaccine for Mothers, Mat for Measuring Maternal Blood Loss, Ultra Low-cost CPAP Device for severe pneumonia, etc.

That’s why “The Conrad N. Hilton Humanitarian Prize” has been awarded to icddr,b in 2017 with $2 million in prize money in recognition of its innovative approach to solving global health issues impacting the world’s most impoverished communities. In 2016 Former UN Secretary-General Ban Ki-moon acknowledged that ICDDR interventions are directly contributing to sustainable development, which helped to significantly reduce infant, child and maternal mortality in Bangladesh and other developing countries.

  1. Context of the innovation


Pneumonia is the leading cause of deaths for infants around the world (WHO report). About 920,000 under 5 years children die from the disease each year, mostly in South Asia and Sub-Saharan Africa. Only in Bangladesh more than 10 million children are diagnosed every year. In developing countries, mortality in children with very severe pneumonia is high even with the provision of antibiotics. Because in severe pneumonia, fluid and mucus blocks the airway in the lungs making it hard for oxygen to get deep into the lungs; the result is hypoxaemia (low levels of blood oxygen) in patients. Very young children are more vulnerable to hypoxaemia. As a result, death in infants are more common in severe pneumonia. Effective oxygen therapy can help the patient to survive. And while the treatment is possible, it is however expensive and not reachable by many families in developing or underdeveloped countries.

Genius Doctor Jubayer Chisti (MBBS, MMed Paediatrics), PhD (Paediatric Respiratory Medicine), from ICDDR invented a cost-effective device made with a simple recycled shampoo bottle to facilitate breathing for children experiencing severe pneumonia. The mainstream pneumonia treatment uses low flow oxygen which is recommended by the World Health Organization (WHO). But Dr. Chisti while working at Dhaka hospital at icddrb saw that this traditional method didn’t have a good success rate and children were dying. He came up with the idea of using recycled plastic bottles in Pneumonia treatment. The device is called “Bubble-Continuous Positive Airway Pressure (Bubble-CPAP)”.

Pneumonia Innovations Summit speech

In Pneumonia, infants have the inability to absorb enough oxygen from ambient air. A child with pneumonia and hypoxemia needs 100% oxygen while ambient air has an oxygen concentration of only 20%. Appropriate flow of oxygen supply through ventilator or regular CPAP can help survive the patients’ lives. But regular CPAP equipment’s high cost (15,000$) has kept it out of reach for most healthcare facilities in developing countries. Moreover, oxygen is not available in many health facilities in developing or underdeveloped countries. In contrast bubble-CPAP is cheap and can be set up anywhere that uses the pressure created by exhaled air of the patient itself to keep the lungs open.

  1. How it works and success:


Below is the method described [9]:

  1. Sanitize a discarded shampoo bottle
  2. Add water & poke a hole
  3. Attach the top to a nasal prong

  4. Insert the nasal prong into the nose

Figure:Traditional b-CPAP versus Inexpensive b-CPAP set-up: 15,000$ versus 2$

It’s a non-invasive method that keeps children’s lungs from collapsing. Pressurized oxygen from a central source was delivered to the patient via nasal prongs/ ordinary respiratory tube. The children inhale oxygen from the source and exhale through the tube which is inserted into the bottle of water producing bubbles in the water. The positive pressure from the bubbles keep the lungs airway open for letting more oxygen in which usually is not possible with a traditional ventilator. Moreover, a regular ventilator costs more than $15000, but Chisti’s Bubble CPAP only goes for $2 or less.

Impact of the innovation

A clinical trial at ICDDR Dhaka Hospital suggested that children who received oxygen with bubble-CPAP oxygen therapy had significant reduction in deaths and treatment failure compared to current standard WHO-recommended therapy [7]. Oxygen therapy delivered by bubble-CPAP improved outcomes in Bangladeshi children with very severe pneumonia with a reduction in death rate by 75%. Use of bubble-CPAP oxygen therapy could have a large effect in developing countries in resource-limited set-up.

  1. Why strategic and responsible

It’s strategic because it creates competitive products or services by the research institute. ICDDR has goals like improve organisational efficiency and cost-effectiveness, ensure financial sustainability; and increase the visibility & impact of their research both nationally & internationally. This innovation gets along well with the institute’s strategic plan and puts its reputation high in the international research field for the successful trial result. Dr. Chisti took a risk because he had no alternative, so his strategic decision makes it work well too.

Impact areas for this innovation are: Sustainable living and Health & Wellness.

The innovation performs to maintain a balance between mitigating economic need and the welfare of the society and environment. The innovation perfectly fulfils the requirements of social responsible innovation for different reasons.

    1. Saving lives:

It has reduced infant mortality rate by a whopping 75% in severe pneumonia cases during the device’s 2 years test run.

4.2. Environment and sustainability:

Also has environmental impact because it saves environment due to plastic bottle recycle, as the idea is to use recycled plastic bottles preferably the ones like shampoo bottle. Thus, reducing plastic wastes from the environment.

4.3. Cost effectiveness:

– This set-up cost only 1.25 to 2 $ in contrast to 15,000 $ for the traditional ventilators

– There is a 50% reduction in need for mechanical ventilation after starting b-CPAP.

– Concentrated oxygen supply with traditional ventilator is expensive; only in hospital at ICDDR the total cost of oxygen consumption dropped from 30,000$ per year to 6000$ per year by using these b-CPAP because it works in low oxygen flow and process is so effective to open up the lungs that hypoxaemia gets cured in few hours compared to the long effecting time during the use of traditional oxygen mask.

4.4. Mitigating health needs towards low- and middle-income countries:

In developing countries and in economically deprived societies, most of the pneumonia patients and infants do not have the access to the traditional ventilators due to its high cost of 15,000$. Oxygen too is not available in every hospital in developing or underdeveloped countries especially in rural areas. So still patients die in severe pneumonia. This cost-effective bubble-CPAP set-up has successfully mitigated this social challenge through mass access to the successful pneumonia treatment.

5. Success story and responses from the World Media

The Dhaka Hospital has standardised implementation of this therapy since completion of the trial. This research work was funded by ICDDR and Centre for International Child Health, University of Melbourne. Until 2017, about 600 children have benefited from the low-cost life saver. In addition to Bangladesh, Ethiopia and Nepal has shown interest in using the Bubble CPAP. Dr. Chisti has shared his innovation to the world, saving countless lives. And with the potential of saving more if his innovation is implemented in developing countries. Implementation have already started in mass population in Bangladesh, the team also visited 20 hospitals in Ethiopia for implementation followed by other developing countries. Because pneumonia occurs more in developing countries due to air pollution, malnutrition related to poverty and overcrowded habitation. So more attention is given to developing countries first.

The researcher has received enormous applauds and positive responses from all over the world. BBC news wrote: “Innovators transforming lives”; “Discarded shampoo bottles save thousands of babies lives”. CNN news mentioned: “Dr. Chisti’s device shows reduction in mortality”. The Economist: “How a shampoo bottle is saving young lives”. ATTN said: “This doctor is turning shampoo bottles into ventilators to help nearly 1 million children who die of pneumonia each year”. Many other national and international media telecasted his interviews and news too [7-19].






Figure: Highlights of some of the news telecasted in international news media [8,14,16,19]

References:

  1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60249-5/fulltext
  2. Bangladesh Crit. Care J September 2014; 2 (2): 71-78 (DOI: http://dx.doi.org/10.3329/bccj.v2i2.24085)
  3. Paediatr Int Child Health. 2014 Feb;34(1):3-11. (DOI: 10.1179/2046905513Y.0000000102. Epub 2013 Dec 6)
  4. https://www.icddrb.org/
  5. UNICEF. “ORS: The medical advance of the century”. Retrieved 1 May 2011.
  6. https://www.rchsd.org/health-articles/pneumonia-2/

Link to the video:

  1. https://www.youtube.com/watch?v=KjBunWdUTu4
  2. https://www.youtube.com/watch?v=T0kQZigVdl0
  3. https://www.facebook.com/attn/videos/1120077171500833/
  4. http://pneumoniainnovations.org/resources/videos/m-jobayer-chisti-at-2015-pneumo-innovations-summit-video-1
  5. https://www.youtube.com/watch?v=pF_DqodpZ5s
  6. https://www.youtube.com/watch?v=-_nroXPhnqA

Webography:

  1. https://www.bbc.com/news/business-40498395
  2. https://www.bbc.com/news/av/business-41416872/the-doctor-who-turned-a-shampoo-bottle-into-a-low-cost-lifesaver
  3. https://www.goodnewsnetwork.org/doctor-uses-discarded-shampoo-bottles-to-cut-mortality-by-75pt/
  4. https://www.economist.com/science-and-technology/2018/09/06/how-a-shampoo-bottle-is-saving-young-lives
  5. https://www.westernjournal.com/l/amandathomason/doctor-uses-shampoo-bottle-cut-patients-mortality-rates-75/
  6. https://biotechinasia.com/2017/11/11/done-bangladeshi-doctor-used-shampoo-bottle-save-babies-pneumonia/
  7. https://www.thebetterindia.com/159126/bangladeshi-doctors-innovation-life-saving-pneumonia/