That thing around their necks

Conceived in January 2014 by Ruchit Nagar, Ife Omiwole, Teja Padma and Leen van Besien in Joe Zinter and Bo Hopkins' class on Appropriate Technology in the Developing World, at Yale University, US, the Khushi Baby prototype of a bracelet that stored medical data won the $25,000 Thorne Prize in April 2014. By December 2014, Khushi Baby had raised around $31,500 on crowd-funding website kickstarter, to pilot its concept in the real world. The first half of 2015 was spent on research. "The goal was to understand the people we are helping, not just dump technology," explains Ruchit.

In July last year, the Khushi Baby team spent three weeks in Udaipur to figure out how best to integrate their project into the immunization programme of Seva Mandir, which vaccinates 4,000 children across 100 villages, annually. Current methods for tracking vaccination history are primarily paper-based, resulting in data loss and difficulty in tracking data. What's more, mothers often miss vaccinations as they are unaware when health camps are held. And then there are mothers who are unaware of the benefits of vaccination. The team spoke to healthcare officials, management staff, NGOs, daimas (social workers trained by NGOs) and field workers, as well as mothers of young children to understand the existing challenges. Their observations resulted in several changes in their design, deployment and efficacy evaluation plans.

The bracelet has been customised for the Indian cultural context and is now a drop-shaped pendant on a kalis (black thread, typically worn by kids in India to ward of evil). Preethi Venkat, a UC Berkeley psychology major, has been managing the project operations since August 2014. She tells us, "An NFC NTAG 216 chip, connected to copper wire, is centered in an epoxy pendant, strung on black-waxed cotton thread. It costs less than $1.00 to manufacture".

Second-year Yale medical student, Praneeth Sadda, built the project's technical back-end. Every time a child is vaccinated, an update is stored in the pendant's 1kb chip (which can be scanned about 10,000 times), on the healthcare worker's mobile app, as well a central server (if/when a 2g connection is available). The app records the first instance of immunization along with the child and mother's details, images and a GPS stamp of when and where the immunization occurred. It lists future vaccination deadlines, instances of non-intervention and more. As the data is stored in the Cloud, information for an entire region can be compiled in real-time, enabling healthcare workers and vaccine suppliers to forecast demand and ship supplies accordingly. For subsequent vaccinations, the health worker just needs to scan the pendant with his/her smartphone app to access the child's current immunization status. Courtesy the near-field communication chip, there's no need of an internet connection to access this information.

"The system is synced but independent; so even with mothers migrating to other villages for work, the healthcare continuum is intact," points out Ruchit. "We designed it to digitize vaccination records in the remotest areas of the world. It would eliminate hours of paperwork, streamline record-keeping and allow health workers to track children that are likely to drop out of the immunization program".

Mohammed Shahnawaz a doctoral candidate at the Indian Institute of Health Management Research (IIHMR), Jaipur, is the Principle Investigator for the Khushi Baby Randomised Control Trial, which began on 12th August 2015, supported by Johns Hopkins University Future Health System's Young Researcher Grant. It will track vaccinations DTP1 to DTP3 of 300 new mothers and children over a period of nine months, in the villages where Seva Mandir is providing immunization/health services. 100 study participants will have an NFC sticker on one arm and serve as the control group. Another 100 will have the NFC pendant as a visual reminder for vaccinations and the last 100, will have the pendant as well as voice reminders (in the local language) of vaccinations due, a day prior to the health camp. The projects purpose is to determine the impact of the systems unique features: the visual signal of the wearable pendant and the personalized voice call reminder system. "Our hypothesis is that the pendant cum voice reminder group will produce the best result," Mohammad tells us. Going forward, Sanjana Malhotra, a Columbia graduate in Psychology and Khemka Fellow will be co-directing the Indian ground operations.

Predictably, the Khushi Baby team has expanded. Doma Sherpa, Aman Preet Kaur, Shirish Dhore and Vijendra Banshiwal of IIHMR spent two months living in the villages to better understand the social context and build capacity. Alam Geer, a Social Work student at Aligarh Muslim University is the village/community liaison, helping conduct surveys, train health workers and provide on-ground assistance. Logan Stone, a Yale graduate in the History of Science and Medicine, manages education supplements, photography and ethnographic elements of the study, creating stories and profiles as he follows health workers into the field.

If the Khushi Baby project succeeds in scaling up as planned, there's hope for the estimated 70 lakh Indian babies who do not get necessary immunizations.