Lifestyle, Tech, Travel

What Causes High Prevalence of Anemia in Rural Hinterland- A case study to assess the gap

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Anemia is most prevalent in low-resource settings, where it goes undetected until becomes severe. Despite the implementation of several initiatives by the Government, India has made only 13 percent progress in eradicating anemia (Global Nutrition Report, 2017).1

Periodic screening and early diagnosis are the keys to controlling anemia. The conventional Hb tests involve invasive methods with the requirement of hygienic infrastructure and skilled healthcare providers. But with the huge gap in basic health infrastructure, rural community members have very little provision for diagnostic facilities.

In Kenduapal Village of PaschimMedinipur, West Bengal shows 88 percent of reproductive-age women have undergone Hb tests for the first time in their lives. They were not aware, if they are prone to a high-risk pregnancy or not. It also indicates the behavioral risk factor which contributes to delay in Anemia detection.

According to WHO recommendation, a non-invasive hemoglobin device is proved to be a good addition. Non-invasive point of care devices can eliminate the potential contamination, bio-hazard handling and can even enable frontline health workers with basic education to perform Hb Test.2 Joseph et al. (2016) also affirm that non-invasive methods are safer than invasive methods and improve patient satisfaction.3Bandyopadhyay S., Neogi, and John D. et al. (2019) further contributed to the fact that as most of the anaemia screening happen in outreach settings, where provision for laboratory support seems difficult, the device ought to be tested in field settings with health workers, non-invasive diagnostic provides viable accuracy.4

iKure’s non-invasive anemia screening initiative started with the vision of reaching out to the last mile community. Members are chosen from the community and are technologically and clinically trained to use them for screening patients. The community health workers are further mobilized to collect other health parameters important to understand the risk of the patients. Instead of using a paper-based format, CHWs use WHIMS that is able to collect patients’ vitals on a cloud server. The data available on the cloud are further sent to medical professionals for referral and counseling.

However, while iron deficiency is the main cause, micronutrient deficiency, inflammations and inherited disorders also contribute to anemia. A baseline report of mother and child health camps reveals that 64% of pregnant women were anemic and 30% with milder anemia. Nutritional experts suggested that a large section of the community are found to be anemic because of women’s ‘‘non-compliance/non-adherence” to the consequences of the anemia and fear and anxiety towards invasive blood drawing.5 Also, women’s consumption rate of IFA supplements are low since they complain of suffering from gastrointestinal upset. Altering such behavior requires regular counselling. iKure’s CHWs are deployed to spread awareness and bring positive health-seeking behavior among pregnant women, new mothers, and adolescent girls.

iKure’s non-invasive anemia testing initiative has been rolled out successfully in school health program and mother and child health camps catchment areas. Within few months, it has gained significant traction such as:

 

  • In West Bengal and Karnataka more than 50% population are found to improve IFA tablets consumption rate.
  • Regular awareness and counseling by iKure medical team during health camps have altered care-seeking behaviour with a reduced percentage of anemic patients
  • The introduction of non-invasive screening devices has improved patients’

    footfall with more women willing for Hb tests

While priorities and approaches may differ according to geographic settings, but strategies to curb anemia remain the same. At iKure, we believe in bringing the desired change soon in India’s rural villages.

Reference :

1. “From promise to impact ending malnutrition by 2030”,Global Nutrition Report,2017,
2. Ma’ayan L., Choppe L., Tikva P., Israel, Lausanne, “Non-Invasive Hemoglobin Screening for Diagnosis and Monitoring of Anemia”, Read More
3. Josheph, Bella., Haider, Ansab., Rhee, Peter., “Non-invasive hemoglobin monitoring”, International Journal of Surgery, 33 (2016):254-257
4. Neogi SB, John D, Sharma J et al. Cost-effectiveness of invasive devices versus non-invasive devices for screening of anemia in field settings in India: A study protocol [version 1; peer review: 1 not approved] F1000Research 2019, 8:861 Read More
5. “Nutritional Anaemias: Tools for Effective Prevention and Control”, World Health Organization, 2017, Read More

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Tech, Travel, Uncategorized

Population Scale Impact Through Societal Platform Lens

iKure’s journey started in 2010 to address the inadequate and inaccessible primary healthcare for the last mile using technology. We have impacted 12 M population across 8 states in India. We have the data capability powered by AI and machine learning algorithm for actionable research interventions and many more. With a full proof model, we began at a small scale. But soon, we learnt the limitation of the model that could reach only a fraction of the population when the problem was common for 70% of the India’s rural villages.

We wondered, can iKure solve the problem individually? Can we create doctors overnight or build infrastructure to solve the problem at scale? The answer was no. The problem is dynamic and multivariant in nature. On one hand, we have primary health centres that remains ineffective and less utilized due to the shortage of staff, resources and quality care and on the other hand, India with a vast population of 1.3 billion needs to build 200,000 health and wellness centres to address the demand and supply gap. In this context, iKure with 200 centres was insignificant to match up to the need.

Societal Platform thinking was important for us to reflect that technology can be the key enabler to scale, but it cannot bring different actors co-create solution together and amplify at a population scale. iKure aimed to build a shared infrastructure for multiple actors to come together to solve the common goal. We wanted to create such infrastructure, where people can access the health system with hope and newer possibilitiesThe Naga telehealth was an effort to introduce the platform thinking of co-creating together with the Government, technology partners, research partners, NGOs and grassroot members. The system opened access to healthcare, prevention and wellness for the entire state of Nagaland leveraging 192 sub health centres and 19 primary health centres.

The prototype model is adapted in Khunti District, Jharkhand with JICA to transform the ineffective health system into a dynamic one. It is serving the district hospitals, community sub-centres, and primary health centres. This has set an example for other state governments to follow, where we are partnering with 5 State governments to leverage the shared digital infrastructure for greater utilization and access to health and wellness centres and promote prevention and awareness at the community level through frontline health workers. The platform is also available in hybrid model to drive rapid adaption and evolution in local context using physical health workforce presence at patient’s door-steps. The shared digital infrastructure has co-created network of engagement at different levels. It has enabled remote health monitoring services through NGOs and self-help groups and addressing the behavioural and cultural barriers that cause vaccine hesitancies in rural villages through frontline health workers. It will bring 200,000 frontline health workers using the shared infrastructure at a mass level. In all these cases, the architecture design needs to foster trust and ownership. Use of AI model can only find relevance, if the platform ensures data privacy for all the actors in the ecosystem. Towards this, iKure is working with ODI-Microsoft to develop an automated open data platform ensuring right data reaches to right hands. A shared and collective understanding of different stakeholders can solve the problem of healthcare in totality. Through our shared infrastructure, we aim to reach out to our beneficiaries irrespective of where they are.  iKure through SP lens believes the power of shared infrastructure can amplify its potential to serve at a population scale.

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