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Enhanced Kangaroo Mother Care

[Updated 1/7] Kangaroo Mother Care (KMC) is a proven WHO-recommended practice that enables mothers to keep their premature babies warm through skin-to-skin contact. There are practical challenges to this wonderful practice being performed 24/7 leading to lower adoption and ineffectiveness. The Embrace infant warmer is a proven innovation that helps babies in developing countries maintain their body temperature with intermittent or no electricity. It has already reached over 100,000 babies across multiple countries. Our idea is to develop one or more product extensions to make it easier for mothers to administer KMC, thereby increasing its uptake and enabling extended care to the baby through a combination of KMC and the Embrace warmer.

Photo of Rahul Panicker
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Keerthi is a new mother in a small village in Karnataka, India. She gave birth to her daughter at a government facility in her district. Her baby was born low-birth-weight, but was otherwise healthy. She was kept in the Embrace warmer next to Keerthi's bed to help maintain her body temperature.

Meanwhile, Keerthi was trained in KMC by the hospital staff. The government hospital, however, was not a place which afforded Keerthi enough privacy to take off her blouse to provide skin-to-skin care. After reaching home, she periodically provided KMC. But, given her other chores and the lack of privacy in a joint-family home, she could only provide intermittent KMC. She wishes she could have done more for her baby. But, at least, her baby survived. She is one of the lucky ones.

KMC is a proven intervention widely promoted by the WHO. Its benefits go beyond warmth and into enhanching breast feeding, mother-baby bonding, and even neuro-development. Unfortunately, despite having been around for 30 years, adoption rates are less than 5%. The Embrace infant warmer has been deployed widely in hospitals in India, and in smaller numbers in Africa and South East Asia, reaching over 100,000 babies since 2012. This innovation has won numerous awards, including being recognized by the WHO as one of the top innovations in global health in 2012. It is designed and manufactured with European medical device certifications. And it has been found to be so easy to use that hospital staff let mothers and family members operate it!

Can we now use this device as a vehicle to enhance adoption of KMC? How about making the device wearable? Or a component that allows seamless transition between the warmer and the mother's skin? How about a training program that integrates both? Can we use technology to transition women to KMC by building their confidence? Can we provide the mother the right tools so that her intent to do all she can for her baby is truly Amplified?

[Update 1/7] Our hypothesis is that the Embrace warmer and its extension(s) can help address some of the reasons behind KMC not being practiced as much, thereby improving the uptake of KMC and enabling extended care for the baby through a combination of KMC and the Embrace warmer. For instance, we are prototyping a sling-like add-on to our baby sleeping bag that would enable mothers to easily and comfortably place babies on their chest. Another idea is to have the Embrace warmer’s carton box foldable such that it can be modified into a structure that supports a comfortable posture for mothers to administer KMC. Another idea is to have a translucent conical enclosure that could hanged from the celing down and give privacy to mothers to administer KMC. We could also have a running animation that explains KMC on a small LCD screen on the heater (a component of the Embrace warmer). This would help improve awareness. Also, the presence of a warmer in the home could serve as a reminder about the importance of warmth and KMC. We could think about other ideas such as mandating KMC before the Embrace warmer can be used again via sensors that would enable activation/de-activation. In the long-term, we envisage healthcare workers being equipped with the Embrace warmer and extensions, which they can deploy in families that need them and take them back after use.
           
We have developed prtototypes of some of these ideas and tested them in the field. Initial feedback seems to indicate strong interest for the Growing Indicator Blanket, Baby Carrier and The Swing Hut. More information can be found in the downloadable documents on the right. 

The key would be to identify 2-3 most important reasons for KMC not being administered through more structured research, brainstorn and develop even more solutions, and test these and existing prototypes more rigorously. This is where the OpenIDEO community and this project could really help us.
 

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

Like Keerthi's daughter, 15 million low-birth-weight babies are born world over every year. Hypothermia is one of the most common ailments they suffer from. Some 3 million of these babies die in the first month of life. Mothers like Keerthi are spread over Africa, Latin America, Middle East, South Asia, and Asia. Can we do something to bring life-saving innovations like KMC to more mothers in these countries? We can start right here in Karnataka, India.

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

1) Go to one of the hospitals nearby where the product is being used, and where mothers are already being trained in KMC. Observe. 2) Make a few prototypes of possible product modifications. Consider co-creating with the nurses and doctors who are familiar with both Embrace and KMC. 3) Get feedback and iterate with the moms. [Update 1/7] We have started early testing and received some great feedback. More information can be found in the downloadable documents.

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

We would like design support in making this happen. We believe the key challenge in making this happen will be human factors. These include: 1) Intuitive and easy to use modified product. 2) Ensuring mothers and staff feel safe and successful in the practice. 3) Easy communication methods and tools that the staff can use to train mothers. 4) Ways in which mothers can train other mothers in their hospital ward or village community.

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.
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Attachments (3)

Design Prototypes and testing_for uploading.pdf

Design prototypes and initial feedback from the field

UX-MAP.pdf

User experience map

48 comments

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Photo of Taz Fear
Team

Congratulations on getting into the the top ideas.
This idea is inspirational, heart warming and it's not an idea that will help children thrive, but let them experience living. I would love to see concept sketches or photos of the 'sling-like'product you plan on using to aid with KMC? What materials would be used and how durable are they, for example are they washable or waterproof wipe clean?
Congrats again - really marvelous stuff!
Tara Fear

Photo of Adam Camenzuli
Team

Looked great when you showed me the carrier in Arusha!

Photo of Rahul Panicker
Team

Hi Adam,
How are you doing? Yes, we have been working on various ideas over the last few months and getting some useful feedback!

Photo of Adam Camenzuli
Team

Doing great - keep up the great work!

Photo of Agata Malkowski
Team

Hi Rahul! You're design solution is not only inspiring but also very motivating! This IS Design Thinking at its best! Congratulations!

Photo of Rahul Panicker
Team

Thank you so much for your encouragement, Agata!

Photo of Laerdal Global Health
Team

Dear Rahul,

Thumbs up for the needs you identified of mothers practicing kangaroo mother care in the facility and home settings. Throughout the past two years, our product development team has been working on solutions aiming to prevent hypothermia and we can easily relate to the challenges you have touched.

For example we learned that some mothers improvise a sand bag to stay in the inclined position, so I can see a great potential in the cardboard seat and swing hut. If you move forward with the swing hut, I suggest you to make it possible for the mother to lean back. I also like the privacy element as in some cultures even expressing breast milk or feeding from the breast require the mother to stay in a private environment.

For the growth indicator blanket or jacket, I like that the concepts allow families to understand and monitor the health of their babies. Note that this also brings along a responsibility on what action to take if the baby is not doing well. Are you planning to incorporate this in the concept?

We had the pleasure to meet Jane Chen from Embrace at the KMC conference in Rwanda and share similar issues and ideas with her. The KMC pocket carrier is very much aligned with the CarePlus wrap we developed to provide continuous Kangaroo Mother Care for preterm and low-weight babies. During the design process, we faced the similar challenges of carrying different size babies on different size parents, as well as tightening the wrap and supporting the neck of the babies. You can check out the CarePlus project and talk with our design team based in India to share knowledge.

It is fantastic to see the different concepts for enhancing KMC, please reach out if we can contribute.

Cansu

Photo of Rahul Panicker
Team

Hi Cansu,

You have come up with some really cool products to address these issues! Super inspiring!

Thank you so much for your feedback. You bring up some really valid concerns and we could certainly explore ways in which we can work together.

May I ask the location at which your India team is based?

Photo of Irene Blas
Team

Nice story and great idea!

Photo of Rahul Panicker
Team

Thank you, Irene!

Photo of Kağan Rüstem
Team

I love the simplicity of the idea. What I love the most is an idea as cheap and easy to implement as this could have such a widespread impact. Its effectiveness for the relatively little amount of effort involved is great.

Photo of Rahul Panicker
Team

Hi Kağan,

We certainly agree. Thank you for the encouraging words!

Rahul

Photo of Jéssica Casagrande
Team

Lots of great ideas! Perhaps the baby carrier handle should be wider and padded. A person who is carrying the baby for a long time may feel pain in the shoulders due the weight.

Photo of Rahul Panicker
Team

Hi Jéssica,

Fair point, indeed! We were trying to integrate the carrier with the baby bed present in our device, and adding a layer of padding complicates things a bit. We will likely explore this in future prototypes. Thank you so much for your feedback!

Rahul

Photo of Sanjukta Das
Team

Hi Rahul! Very inspiring idea. Is there any form of training that you provide to the mother for usage? What channels do you use for the same? Also, what approximate price points are the bags accessible to mothers? If KMC is taught and propagated well it is a no cost solution for the poor to save babies, is this intervention going to make KMC more efficient or is going to make adoption of KMC easier? We look forward to knowing more about your idea and also, if you have any feedback on our idea in the contribution section!

Photo of Rahul Panicker
Team

Hi ayzh! Thank you for the feedback. We intend to conduct the training via healthcare workers. Another idea is to have a small LCD screen on our product with rolling training animations. Our solution is to make it easier for mothers to administer KMC.

Photo of Sanjukta Das
Team

Thanks Rahul! Looking forward to see your idea develop!

Photo of Rahul Panicker
Team

UX map uploaded. Thank you everyone!

Photo of Natalie Lake
Team

Hi Rahul,

This is a bit of an odd question. Have you gotten any feedback about the fabric and look of the embrace warmer? Have you guys looked into any ways to mimic the KMC practice but using more traditional fabrics and designs to make the embrace warmer? I realize that this is kind of silly, however both my sisters work in the fashion industry and I wonder if it would help increase usage? Have you noticed any stigma associated with the usage? Just some food for thought!

Looking forward to learning more about your idea!

Photo of Rahul Panicker
Team

Hi Natalie, this is indeed a really valid question and we spent quite a bit of time thinking about it when we were designing the Embrace warmer. The warmer was designed to be a re-usable equipment in hospitals and community settings. While our initial prototypes were developed using materials like cotton, we soon realized that regular cleaning was a major challenge in low-resource hospitals. Oftentimes, we would find our baby sleeping bags visibly soiled with baby poop and hospital staff were not washing these bags periodically, posing a hygiene hazard. We hence shifted to more standard waterproof hospital linen that could be easily sanitized with hospital spirit, could be quickly dried after washing (particularly during winters) and could meet biocompatability requirements.

For the KMC add-on to the Embrace warmer, we haven't given as much thought to the materials yet but I suspect we might go with something easily available, affordable and acceptable like cotton. But you bring up a really valid point, material selection will probably have some impact on usage rates and we will try and test this during our field studies. Do you have any suggestions on potential materials?

Photo of Natalie Lake
Team

Hi Rahul,

I think I could for Latin America, but I have very little experience with the markets in Africa, Asia and the Middle East . I think making it out of materials they use for local dress, would help blend the technology into the culture and also might make the technology feel familiar in a way.

Photo of Rahul Panicker
Team

True, Natalie. I guess it will be some time before we launch the project in Latin America.

Photo of Rahul Panicker
Team

Hi everyone! We have uploaded a new document with our design prototypes and initial feedback from the field.

Photo of Chioma Ume
Team

Awesome, thanks for sharing! Can you explain a bit more about how the blanket helps a mother know her baby's weight? Is it an estimate based on their size, or based on actually weighing the baby? How are you planning to incorporate the feedback you've received in the field – are you moving forward with all of the initial prototypes?

Photo of Bettina Fliegel
Team

Hi Rahul.
I have the same question as Chioma regarding the blanket. Is this an estimate of overall growth overtime?
Interestingly there is a tape/tool, used in Pediatric Emergency Medical Care, which estimates weight, in relation to height, in infants and children using colored bands! The Broselow Tape was developed as a tool to reduce medication errors during pediatric resuscitation. The tape allows one to quickly determine a child's weight range, as he is measured with this tape from crown to heel. The color zone at his heel has his estimated weight range. (bands of color run from head to heel) Your blanket design and the purpose behind it - to monitor growth - brought to mind this tape. (I am a pediatrician, US based.)
http://en.wikipedia.org/wiki/Broselow_Pediatric_Emergency_Tape

Photo of Bettina Fliegel
Team

Another thought - Regarding the design of the kangaroo carrier. There are carriers used by moms of premies in the US and other developed countries. Can "mom" community blogs be useful as a place for research on what mothers like - pertaining to design, materials etc. - perhaps a resource for protoype ideas which can be modified for local context?

Great that the designer is getting the prototypes in front of users, professionals, and adjusting for safety. Good luck!

Photo of Rahul Panicker
Team

Hi Chioma, the weight is estimated based on the baby's size and the blanket is to serve as a tool to help mothers notice their baby's growth or the lack of it. It is relatively early to completely rule out our current ideas but The Snake, for instance, did not receive overwhelmingly positive feedback. We are looking to conduct more primary research to uncover more reasons, and brainstorm, design and test newer prototypes too.

Photo of Rahul Panicker
Team

Hi Bettina, did not know about the Broselow Tape! Thank you for pointing that out. We were using the blanket more as an indicator to the mother to observe if the baby is growing or losing weight - meant it more as a signalling effect than an accurate measurement of weight.

We have also been looking at carrier solutions in developed markets. The different local context and affordability issues make it a bit more challenging to adapt some of the nicer solutions, but we will test some of these designs and materials in subsequent iterations.

Thank you again for your support!

Photo of Rahul Panicker
Team

Welcoming Jules Sherman as a project team member. We are excited to be working with her on this project!

Photo of Japhet Aloyce Kalegeya
Team

Great idea, with a nice picture, Can you consider this insight and add in your idea, lack of knowledge on the importance fresh air, Child feeding and body temperature to children is a challenge faced parents in low income communities, so children can not thrive in their first five years.
Provide education on most important things in raising a health children can help parents to care and protect their children of under five years to parents from low income communities.
The audience of this idea are parents from low income communities especially Sub Saharan Africa, Tanzania and Ethiopia.

Photo of Rahul Panicker
Team

Hi Japhet,

Yes, awareness about key issues remains a key bottleneck in these settings. We are looking to integrate these aspects into the training program and other platforms we are deliberating to help improve awareness. Thank you!

Photo of Jonathan Joanes
Team

Hi Rahul,

I really like the idea peer teaching, from one mother to another. They will share empathetic view as to how to feed and care for their children correctly and safely.

Perhaps this could be implemented like a workshop in a community where mothers are encouraged to come along to teach and learn from each other. Would be a nice way to bring the community together and mothers can support one another

Photo of Rahul Panicker
Team

Hi Jonathan,

Yes, indeed! Community-based learning often works wonders in these settings. We will definitely include this. Thank you!

Photo of Guy Viner
Team

Something we'd encourage you to think about is how you might update your Summary section (text above the image gallery) to encapsulate what your idea actually entails briefly and clearly.

Here's a template if you need some help, though feel free to come up with your own clarifying sentence structure.

Our idea is a_________________ [campaign/app/service/program/online platform/toolkit/social enterprise/etc.] that tackles the problem of _____________[the issue being addressed ] by __________[what your idea looks like in practice].

See some Summary examples from the Amplify Team on a previous challenge here: https://openideo.com/challenge/womens-safety/shortlist

Photo of Guy Viner
Team

And here's a friendly tip: update your OpenIDEO profile so folks can dig who they're collaborating with. Think skills, experience, passions & wit! Looking forward to seeing more of you across conversations on this challenge...

Photo of Rahul Panicker
Team

Thank you Guy! Have incorporated your feedback. Appreciate it.

Photo of Jules Sherman
Team

Encouraging Kangaroo Care in US NICUs is also a big priority...barriers like fear of removing a baby from an isolette because of tubes/ventilators connected to baby, as well as lack of privacy in open bay NICU designs (which is the typical layout) inhibit parents from doing Kangaroo Care. Privacy, ease of transition between incubator and parent as well as a comfortable chair is essential when encouraging Kangaroo Care in US hospitals. It's a problem that needs to be addressed from a few different angles--at least in US NICUs...your solution will probably be very different depending on the context in which you focus. Focusing on a particular context and use case will help to define a solution/s. There are probably a few different solutions depending on context. The solutions might also need to incorporate another physical element besides the baby holder. What I mean is that some sort of portable privacy screen might need to be part of the kit.

Photo of Chioma Ume
Team

Hello Rahul! We've been having early childhood experts take a look at the ideas in Refinement and here is some of their feedback: Explaining why combining KMC with Embrace is valuable would help people understand the service more clearly. How will this device fill the gaps and challenges identified in relation to the uptake of KMC? How will you design and test the new idea?

Photo of Rahul Panicker
Team

Hi Chioma, thank you for sharing this feedback! We just updated the Refinement Q&A document with our responses. We will also upload the user experience map and some design sketches in the next day or so. That would also help clarify some of the questions.

Photo of Bettina Fliegel
Team

Hi all. I read about your infant warmer after you first developed it. Fantastic solution for a void in health care! Thank you! Are the Embrace Warmers available for mothers to take home from the hospital? What is the cost for each warmer?
Are you looking to fit the warmer into a snuggly of some sort?

The soiling multiple times a day is a big problem to address. Of course mothers would find that difficult to handle. What ideas are you thinking that address this?

Does the infant need to be positioned on the chest for KMC, or can positioning be in any place as long as there is skin to skin contact? can they place the infant on their back?

Looking forward to hearing some of your ideas!

Photo of Rahul Panicker
Team

Hi Bettina, thank you for the encouragement! We are developing an alternate version of the warmer that would not require any electricity at all and that mothers could take home from the hospital. We are still working out the cost structure and this could be a single-baby-use warmer.

We have already pilot-launched a re-usable home-based warmer for deployment via rural healthcare workers. We envisage local healthcare workers stocking these warmers, deploying it at homes in their community when a delivery takes place and then getting the units back after sometime. This re-usable warmer may be priced at ~$200 or lower and local governments could purchase them and pass them on to the healthcare workers.

On soiling, we haven't been able to come up with any unique solutions. We would love to get some help from the community on this. Using diapers seems to be the easiest solution at this point.

For reaping full benefits of KMC such as enhanced breast-feeding, there should be skin-to-skin contact near the chest area. Also, as KMC must be administered for 3-6 months after birth, placing the baby on the caregivers' back might lead to head-positioning issues etc.

Thank you!

Photo of Rahul Panicker
Team

Hi everyone! Thank you so much for all your feedback. We have just uploaded our answers to your questions and are in the midst of collecting some feedback from the field. We will come back with more updates.

Photo of OpenIDEO
Team

Congratulations on making it to the Zero to Five Challenge Refinement List, Rahul! We like that you are attempting to build on a successful product that is low cost, effective and human-centered. Your message of empowering mothers so that they feel successful is an inspiring one. We’d like to get a better understanding of what you are envisioning working on. Are you planning to design a physical product for mothers to use? Would it be an extension of the Embrace warmer or potentially an independent product? You give a few examples of things you could do to test this idea – have you conducted any of them? What have you learned? How can you get a better understanding of the reasons why so many women don’t use KMC, despite it’s proven effectiveness? How would your solution take into account the surrounding system and address some of these underlying reasons? We notice that Embrace Global also submitted an entry in the Ideas phase. Are there elements of the other idea that you plan to incorporate into this one? Check out tips for Refinement http://ideo.pn/0to5-tips-refine.

Photo of Chioma Ume
Team

Hi Rahul! We'd love to learn more about this idea – hope to hear more from your team during the next two weeks of the Refinement phase!

Photo of Uve Kindia
Team

I like the concept and idea thinking behind this but wouldnt that process take away that bond with mother and child at early stages. Skin contact is very ideal to feeling warth as a child

Photo of Diini Omar
Team

This is a great idea, practice that enables mothers to keep their premature babies warm through direct skin-to-skin contact.

Photo of Vishagan Baskaramoorthy
Team

Whilst the embrace warmer effectively maintains the body temperature of infants, KMC also acts as a bonding experience between the mother and child. Bringing these together into one design should help solve the respective issues of each. What are the reasons for the adoption rate being so low? How are the mothers currently caring for their babies in Karnataka? Maybe look into the type of activities/chores the mothers do in Karnataka to come up with a design that can adapt to these when worn. Also perhaps look into how animals care/carry their young for inspiration (as the example Bidur mentioned, the kangaroo pouch). Also, well done on going through to the next stage!

Photo of Bidur Gurung
Team

Hey Rahul! Very interesting idea! This really seems to have an effective process on physiological and psychological warmth and bonding. What could be the reason, KMC's are not yet practical in some societies? Could there be cultural and religious concerns? Lack of privacy and chores could possibly be an issue in low income communities, perhaps you could design a product that either be wrapped around or put on (using Kangaroo's pouch as an inspiration) which does not interfere in their everyday tasks nor their privacy.