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Baby Shell parenting assistant

Beauty Manbo is a young mother of one child and pregnant for the second time. One of her friends she recently lost her baby due to pregnancy related complications. She lives in a remote village in Malawi. The nearest by health facility, a little dispensary, is about 2 hours walk. Beauty does not have a mobile phone, unlike her husband. Often the husband needs to stay away several hours to get his phone charged, this add to her discomfort of having to take care for the other child and the house while pregnant. Seeing what happened to her friend and having heard about ANC visits from the community health worker, she decides to take her time to go to the dispensary in occasion of one of the "charging" trips of her husband

Photo of Maurizio Bricola
6 8

Written by the dispensary she sees a poster that shows a little "talisman" called Baby Shell that it seems to have magic power and could assist her with putting her child to sleep and check her self during her current pregnancy. She really wants to have it.

It turns out she can get one for free if she does an antinatal visit before the 3 month. She decides to go for it.

During the visit the nurse shows her how to use it and gives her an illustrated little book (the user manual).

Once home Beauty carefully opens the "talisman".
First thing she really wants to do is to read a nice sotry to her child so she can ave a nice sleep after all that travel. She finds one of the very cool stories about a cat that learned a bird to fly. While reading it to her child she discovers how important the right motivation and mindset are for her child, she really would like to know more on how to stimulate that, so she keeps reading the story even if her child is sleeping already... while doing so she realises she was also, and still is, reading to her little baby who is in her belly.
Beauty feels kind of enlighted and delighted by her new "blink blink talisman".

Once her child is asleep she start having a look at the book she got from the nurse. She decides to register her current pregnacy first.
The "talisman" asks her what was the last time she had her menstrual cycle. Beauty thinks a little and enters the information. She gets said that she could deliver in 30 weeks from now.

"Have you done your first ANC visit?"

"Yes" answers Beauty, quite happy about her decision.

"Well done Beauty, your next ANC visit will be on {date}
I will do my best to assist you and your baby in the next weeks. Feel free to use me any time you need."

..Back to main menu..
  • Register
  • Self check
  • Tips and remedies
  • Live healthy

To be continued..

Every year, complications from pregnancy and childbirth claim the lives of nearly 300,000 women and permanently disable many more, mostly in developing countries. More than 2.6 million babies are stillborn, another 2.9 million die before they are a month old, and many suffer neurodevelopmental disabilities and impairments. Most neonatal deaths are caused by preterm birth, asphyxia during birth, and infections such as sepsis, pneumonia, and meningitis .

To circumvent these challenges, we want to explore the opportunities of a new concept, called Baby Shell. Baby Shell is a digital standalone wearable device that provides health information to women during their pregnancy until children of 5 years old. The Baby Shell empowers the women by giving reminders of antenatal visits and vaccinations, but it also provides self-assessment tools and DIY tips and remedies, for example Oral Rehydration Solution (ORS) for infants, along with information and tips on nutrition.

To enanche its adoption we would like to explore the possibility to add a "reader" functionality. Mothers and fathers could use Baby Shell when putting their children to sleep (babies sleeps about 3 to 5 times a day). In so doing we could provide parents with local relevant stories to read to their children.
BabyShell is powered by solar cells and function as a solar calculator, no need of being recharged regularly and its 'large scale" production costs will be below 5$ per unit. All information is saved and accessible in the device, so no network is needed. Ideally it will have an average lifespan of 5/7 years and it will be able to serve, in average, a mother and 2 infants. Device can be connected using mini USB to computers at health facilities for updating information when needed.
This product is still in its concept phase. We would like to further develop the concept into a functional prototype that can be used in pilot projects. The solution should be a very low cost product, with a simple GUI, low power consumption, which can handle the circumstances of the rural area in developing countries. Hardware technical specifications need to be verified and tested, like usage of e-ink screen vs lcd, , 3D printing modular design and local 3D printing production.

Update 08/12

Thomas has made some design of 3d prototypes of the BabyShell to explore its shape. We have considered also the option to turn it into a babytoy (to be sure that the usage will be constant) although that will add sensible costs to its production.

Thanks to all of you that have stopped by and helped thinking through!

Upadate 3/12/2014

Thomas our bachelor student has made a soft version prototype of the of BabyShell. I had the pleasure to run a test with a target user during my field trip to Chikwawa. Seeing the tight timeline, we were not able to translate the UI. Our user did not have a mobile phone, neither she had everused a laptop before. Ralph, ICT officer of Chikwawa Diocese has kindly explained the context and test as well as translated the UI and prompt to the user . The Health Survelliance Assistant of that village and a couple of Community Health Workers were present at the test.

Main findings
  • The user found it to be useful, she liked the the self check feature.
  • The user had difficulties in navigating the prototype.
  • The up and down arrows turned out to not be so intuitive, at least in this soft version of the prototype.
  • The user main effort was trying to understand how to navigate through the application and what is happening in the screen.
  • CHWs that assisted to the test were confident they could use it, especially after being trained in using the CommCare application on features phones.
  • CWHs think that for a their clients might be very difficult. Although they think that with 6 hours (splitted in 2 days) training their clients might be up to speed.
  • CHWs liked the story telling feature because, they said, it increase interaction between parents and children, as well it is useful for teaching good beahviour and cultural identity. They added that it can create a family dynamic, since,  usually fathers do not read stories to their children, neither mothers do, may be once a week, so they think that feature can really help.
  • If they were to sell it to heir clients: they think it might be worth 3000 MKW (5 euro - 6 dollars) another said 2000, and one said she won't be able to buy.
  • A mobile phone costs from above 6500 MKW (about 12 USD)
From this test we have decided to proceed with translating the UI. Create 2 alternative navigation layouts.
Repeat the test with a group of 3 to 5 users

Update 22/11/2014

We have asked some questions to Community Health Workers and Mothers. Here below the questions and answers. Soon we will publish our analysis.

Health workers
What organization do you work for?
Montfort Hospital
How long have you worked there?
HW 1:8 years
HW 2: 6 years
HW 3: 4years

What is your function there?
HW 1: HSA’s
HW 2: Maternity In charge
HW 3: Clinician

What is rewarding in your job?
HW 1: I got experience in communication skills to the clients
Trainings on other sections which were not related to my field
Counselling skills
HW 2: Trainings on other sections which were not related to my field
HW 3:  My daily experience on how to handle clients

(Daily routine)
Can you describe your last workday?
HW 1: My last day was busy but managed to do everything
HW 2: My last day was busy during the day not busy at night
HW 3: My last day was busy

Do you consider the just described day, as an average day of your work? If not, why not?
HW 1: It was not because I was involved in other works like ANC services and Vaccinations
HW 2: yes I do
HW 3: yes I do

How many different patients do you see on such a day?
HW 1:20 patient’s (8 woman and 12 under 5)
HW 2: 15 deliveries
HW 3: 60 patients

What makes your job difficult?
HW 1: Mode of transport to the community and the hospital
HW 2: Complicated cases coming for delivery
HW 3: Lack of expertise on certain areas which I see could be of help

What do clients usually do with your advice?
HW 1: They follow the advice but a small number doesn’t
HW 2: follows my advice
HW 3: Follows my advice

What is the most difficult when giving advice to a client?
HW 1: Understanding of the people
HW 2: following the given advice
HW 3: Understanding and following of the given advice

How do you feel when trying to understand what problem the client might have?
HW 1: eager to help in whatever way possible
HW 2: Getting the close insight of the problem
HW 3: Eager to help

What are the most common and dangerous diseases for children 0 to 5? What should be done to mitigate them?
All the 3 people gave common answers as follows
Pneumonia – Health education to parent and early coming of the child to the hospital when sick and availability of medicine, train workers more on related issues.
Diarrhea if not treated early - hygiene practices
Measles – early testing of the diseases and campaigning

What are the most common causes of death for infants?
Visiting of witch doctors instead of the hospital when a child is sick
Ignorance of the common diseases by the parents

How often should a pregnant woman visit your organization you think?
All three answered this
HW 1: 4 times for ANC, whenever a complication has been developed and coming for delivery
How often do you think most pregnant women visit?
All three answered this
3 to 4 times for ANC
Others 2 or 1 months before delivery, others late coming and when complications comes worse.

What would you do different if you were in the position of a pregnant woman?
HW 1: Make sure all visits are done and reports early to the hospital for delivery
HW 2: Come early for delivery
HW 3: Report early for complications

How do you think a book with relevant health information for maternity, child health and sexual reproductive health and rights could help your client?
All three answered this
It could be good to them if they can manage to read

How much would your client be willing to pay for such a book?
All three answered this
Many people like free things but if it will be 300kwacha maybe they would try.

For mothers:
(warm up)
How many children do you have?
Mother 1:5
Mother 2: 2
Mother 3: 3

What are their names and ages?
Mother 1: Maxwell- 15, Joyce-12, John- 17, Peter-10, Manuel- 8
Mother 2: Mary-8 and Joshua-2
Mother 3: Edgar-5, Esnath-3 and Daniel-1

How old were you when you had your first child?
Mother 1:22
Mother 2: 15
Mother 3: 18

(Daily routine with children)
At what times did your infant(s) go to sleep yesterday?
Mother 1:9:00 pm
Mother 2: 9:30 pm
Mother 3: 8:45 pm

At what times did you sleep yesterday?
Mother 1:11 pm depending on the weather condition if hot we sleep late to allow the weather to calm
Mother 2: 10 pm depending on the weather condition if hot we sleep late to allow the weather to calm
Mother 3 11:30 pm depending on the weather condition if hot we sleep late to allow the weather to calm

Are those times representative for the typical day for you and your children?
                                     All answered no

At what times did you and your children eat?
Mother 1:6:30pm
Mother 2: 7:30pm
Mother 3:8:00 pm

What type of food did you have?
Mother 1: Nsima and beans
Mother 2: Rice and Beef
Mother 3: Nsima and fish

Are those times and food types usual for you and your child(ren)?
All answered yes
What is the activity that you like to do most with your child(ren) and why?
All answered Sitting down and telling them stories

What activities does the father do with his child(ren)?
All answered nothing

How does the father support you with child care?
By helping me to go to hospital (transport and medical bills)

(Sleep-time stories)
What did you tell your child(ren) yesterday before putting her/him/them to sleep?
Mother 1: A bed time story
Mother 2: Nothing just told them to go to sleep
Mother 3: Nothing they just go to bed themselves

What, if any, are stories you tell your children?
All answered Just old stories to be able to give them guidance

What are stories that your parents told you when you were a child?
All answered Same stories

(Antenatal care)
What type of health care support do you make use of?
All answered Outreach Clinics which come to their villages

Who are the people and or institutions that help you when you are pregnant or child is ill?
Mother 1: Health workers at Montfort hospital and Chikwawa district hospital
Mother 1: Mother 1: Health workers at Montfort hospital and Chikwawa district hospital
Mother 3: Mother 1: Health workers at Montfort hospital and Chikwawa district hospital sometimes a witch doctor

What type of health support do you need and would like to receive?
Mother 1: Counselling on nutrition and ANC services
Mother 2: Common diseases to be experienced when pregnant and to my child.
Mother 3: Counselling on nutrition and ANC and common complications.

What is keeping you from getting that degree of support?
Mother 1: Distance and paying hospitals and free once are far
Mother 2: Distance
Mother 3: Distance

What subject would you like to know more about concerning health, pregnancy and child health?
Mother 1: PMTCT
Mother 2: What is involved at ANC
Mother 3: to know the importance of all the Under 5 Vaccinations

(If proper reply ask: How much would you pay for a book or for receiving that information on your phone?)
Mother 1: life hard in the village, to pay will be hard
Mother 2: 100 Malawian Kwacha
Mother 3: 200 Malawian Kwacha

Which people are extra important to you when you are pregnant?
Mother 1: My mother and Husband
Mother 2: My mother and husband
Mother 3: my mother

What would you advise other women for their first pregnancy?
Mother 1: get tested on HIV
Mother 2: go to ANC and deliver at the hospital
Mother 3: don’t disregard advice when given

(Mobile phones)
Do you have a mobile phone?
Mother 1: no
Mother 2: yes
Mother 3: yes

(if yes)
What type of phone do you have?
Mother 2: ZTE
Mother 3: Nokia 1200

Where is it right now?
Mother 2: With me
Mother 3: Charging place

Where do you normally keep your phone?
Mother 2: In my purse
Mother 3: in my house

How do you carry it around?
Mother 2: In my purse
Mother 3: On my cloth (chitenje) or my purse

How and where do you charge it?
Mother 2: charging stations
Mother 3: in my house

How often and how long is your phone without charge?
Mother 2:3 days long
Mother 3: 2 days long

If you could change the shape and size of your phone, how would you change it?
All answered get another 1 if I can manage

Stay tuned!


Update 20/11/2014

We have formed a team! Together with Ralph Kawatira, ICTO at Chikwawa Diocese in Malawi and Thomas Belen, Bachelor in Creative Technology at the University of Twente in The Netherlands.

Ralph will assist us in field evaluation, field testing and ensuring that our product is designed with and for Malawian women and families.
Thomas is already experimenting with producing organic plastic for casing and developing user interaction and designing the GUI.

We have submitted few questions (Thanks Ralph for taking the time) to pregnant women in rural Malawi. We are due to post the result here.
Stay tuned!

Who will benefit from this idea and where are they located?

Rural families and communities in Sub-Saharan Africa, starting in Malawi and scaling in Uganda, Zambia, Tanzania, and Ghana.

How could you test this idea in a quick and low-cost way right now?

I would make the first prototype and go through several iterations in the field together with the users and stakeholders involved.

What kind of help would you need to make your idea real?

Persons with electronic engineering background, maternity and child health experts, nutrition experts, Assembly (or C) developer, story tellers, 3D designers.

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.


Join the conversation:

Photo of Bettina Fliegel

Hi Maurizio. I like your approach regarding interviewing all sides of the health care story - care givers and mothers. The questions you asked gave a real feel for the on the ground situation. It appears that distance is a huge factor in accessing care. (Limited access to transport contributes to the high incidence of maternal mortality across the developing world.) That being the case do you envision your product being useful in anyway to solve this problem? You mention it is a 2 hour walk. Are there roads between the village and the hospital? Is there a way for the community to arrange group rides - or to arrange piggyback rides - traveling a certain distance and then meeting up with another ride? If women from surrounding villages coordinate appointments perhaps there can be coordination of transport? Perhaps women can make the phone charging trips coordinating them with their appointments, which can free up the husband to work. Can your device be used to assist in some way?
Excited to hear more as you develop baby shell.

Photo of Maurizio Bricola

Dear Bettina thanks for your comment, this has motivated me to post one old idea I had that suits very well this challenge check:

The device helps the mother (or user) to be informed on nutrition, pregnancy progress, run self diagnosis and be able to make DIY proven remedies (like ORS) that save life of children.

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