A Sustainable Engineering Solution for Pediatric Dehydration in Low-Resource Clinical Environments
Abstract
Engineering efforts in low resource environments pose a unique set of challenges, requiring an in-depth understanding of local needs, comprehensive mapping of community resources, and extensive collaboration with local expertise. The importance of these principles is demonstrated in this paper by detailing the novel design and field demonstration of an affordable, locally manufactured intravenous fluid regulation device. Collaboration with clinical personnel in Uganda and Malawi guided device design. In-country physicians emphasised the need to regulate volume of intravenous (IV) fluid delivered to a paediatric patient without use of electricity. The proposed device regulates IV fluid delivery within ±20 mL of total prescribed dosage, providing a method of reducing fatalities caused by over-hydration in low resource environments; the feasibility of building the device from local resources was demonstrated by a field research team in Malawi. The device was successfully constructed entirely from local resources for a total cost of $46.21 (USD). Additionally, the device was demonstrated in rural clinics where 89 % of surveyed clinical staff reported that they would use the device to regulate IV fluid delivery. This paper emphasises the importance of collaborating with communities for community-based engineering solutions. Mapping community assets and collaborating with local expertise are crucial to success of engineering efforts. Long-term, community-based efforts are likely to sustainably improve health outcomes and strengthen economies of communities worldwide.
References
Black, JK 1999, Development in theory and practice: paradigms and paradoxes, 2nd edn, Westview Press, Boulder, Colorado.
Hagopian, A, Thompson, MJ, Fordyce, M, Johnson, KE & Hart, LG 2004, ‘The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain’, Human Resources for Health, vol. 2 no. 1, doi: 10.1186/1478-4491-2-17
Lehmann, U, Dieleman, M & Martineau, T 2008, ‘Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention’, BMC Health Services Research, vol. 8 no. 1, doi: 10.1186/1472-6963-8-19.
Malkin, R 2007, ‘Barriers for medical devices for the developing world’, Expert Review of Medical Devices, vol. 4, no. 6, pp. 759-763, doi: 10.1586/17434440.4.6.759
Marchal, B & Kegels, G 2003, ‘Health workforce imbalances in times of globalization: brain drain or professional mobility?’, International Journal of Health Planning and Management, vol. 18, no. S1, pp. S89-101, doi: 10.1002/hpm.720
Mohan, G 2014, ‘Participatory Development’ in Desai, Vandana, Potter & Robert (eds.), The Companion to Development Studies, 3rd edn, Routledge, London, pp. 131–136.
Oden, ZM, Mirabal, Y, Epstein, M & Richards-Kortem, R 2010, ‘Engaging undergraduates to solve global health challenges: A new approach based on bioengineering design’, Annals of Biomedical Engineering, vol. 38, no. 9, pp. 3031–3041, doi: 10.1007/s10439-010-0036-0
Reid, SR & Bonadio, WA 1996, ‘Outpatient rapid intravenous rehydration to correct dehydration and resolve vomiting in children with acute gastroenteritis’, Annals of Emergency Medicine, vol. 28, no. 3, pp. 318-323, doi: 10.1016/S0196-0644(96)70032-X
Rouhani, S, Meloney, L, Ahn, R, Nelson, BD & Burke, TF 2011, ‘Alternative rehydration methods: A systematic review and lessons for resource-limited care’, Pediatrics vol. 127 no. 3, pp. e748–e757, doi: 10.1542/peds.2010-0952
Schumacher, EF 1973, Small is beautiful; economics as if people mattered, Harper & Row, New York.
Shah, K, Skerrett, E, Nojoomi, M, Walker, T, Maynard, K, Pan, M, Flynn, B, Yuan, M, Horton, P, Vaughn, T, Miros, R, Molyneux, E, Saterbak, A, Oden, ZM & Richards-Kortem, R 2015, ‘A new tool to prevent overhydration of children receiving intravenous fluid therapy in low resource settings’, The American Journal of Tropical Medicine and Hygiene, vol. 92, no. 5, pp. 92, 1053– 1058, doi: 10.4269/ajtmh.14-0495
Vujicic, M, Zurn, P, Diallo, K, Adams, O & Dal Poz, MR 2004, ‘The role of wages in the migration of health care professionals from developing countries’ Human Resources for Health, vol. 3, no. 3, doi:10.1186/1478-4491-2-3
World Health Organisation 2014, Country Cooperation Strategy at a glance – Malawi, fact sheet, viewed 11 March 2016, http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_mwi_en.pdf
World Health Organisation 2013, Guideline - Updates on the management of severe acute malnutrition in infants and children, Geneva, viewed 11 March 2016, http://apps.who.int/iris/bitstream/10665/95584/1/9789241506328_eng.pdf
World Health Organisation 2005, Department of Child and Adolescent Health and Development - The treatment of diarrhoea: a manual for physicians and other senior health workers (WHO/FCH/CAH/05.1), Geneva.
World Health Organisation, The World Bank 2015, Access to Modern Energy Services for Health Facilities in Resource-Constrained Settings: A Review of Status, Significance, Challenges and Measurements, World Health Organisation, Switzerland, viewed 11 March 2016, http://apps.who.int/iris/bitstream/10665/156847/1/9789241507646_eng.pdf
Authors retain copyright over their work and licence the work to the journal under a Creative Commons 3.0 Attribution (CC-BY) Licence. The CC-BY licence is the most open licence in terms of enabling free distribution and communication of the work. Works prepared using contents of the journal must reference the author(s) and the journal.
