Health-care innovation in the Global South

Epidemiologist Shams El Arifeen highlights a low-cost, efficient technology that can save the lives of pneumonia patients in the developing world.

bihar ICU
An intensive care unit in Bihar, the poorest state in India. Healthcare providers in poor countries often lack access to many life-saving technologies that are too expensive for them to afford. Image: Travel Stock /

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, which accounts for 15 per cent of all deaths of children under five years old – nearly a million children – each year. A key component of the treatment of hospitalized 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.

But with a combination of medical expertise and inventive thinking, Jobayer Chisti, my colleague at the health research organization 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 Organization 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 high-flow oxygen therapies. In fact, just 4 per cent of infants died when treated with the improvised bubble CPAP device, compared with 15 per cent of those receiving low-flow oxygen therapy.

Bubble CPAP delivered with the ultra-low cost apparatus was shown to be as effective as the standard low- and high-flow oxygen therapies.

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, low-cost 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 implications 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 recognize 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.

Shams El Arifeen is an epidemiologist and senior scientist at icddr,b in Dhaka, Bangladesh, and the first senior director of its newly established Maternal and Child Health Division. 

Copyright: Project Syndicate, 2016.

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