Anapoorni is a 44-year-old mother of four, and a domestic help in Chennai’s West Mambalam. But her four children, two daughters and two sons, would have actually been five, had Anapoorni’s first born survived. The two-day-old infant had contracted an infection that led to his death. Annapoorni remembers being delivered the bad news as she lay inside a makeshift hut, and a marutthuvacchi (an untrained midwife) massaged her ankles.

“I remember feeling very upset,” she recalls. “After all, it was a boy.” Infant deaths are a part and parcel of life in her native village near Tindivanam, a town in Tamil Nadu. “People have made their peace with it,” she says, as her face breaks into a wry smile.

Globally, “every hour, an estimated 340 babies die within the first week of their birth. Around 99 per cent of these deaths occur in low/middle-income countries such as India. And pre-term birth, asphyxia (lack of oxygen) and sepsis are three of the leading causes,” read the first three bullet points on the opening slide of Arun Venkatesan’s PowerPoint presentation.

We are sitting in the head office of Phoenix Medical Systems in Chennai’s Ekkaduthangal. Venkatesan is its Chief Technical Officer.

Also present are Managing Director V Sashi Kumar, Binu Nainan, Head of Neonatology, SRM University, and Govind Rao, Professor of chemical, biochemical and environmental engineering at the University of Maryland, Baltimore County (UMBC), US.

“These are all extremely preventable causes,” says Rao. He and his team from the UMBC believe that they have found a solution, which can address “two out of the three issues mentioned in the slide”.

They have managed to do this by improving upon an already developed low-cost incubator’s design, and by including built-in sensors. Pheonix Medical Systems will modify this initial concept to manufacture it at a low cost. Its second, more important, role, according to Venkatesan, will be to eliminate risks in the design to conform to ISO 13485 standards, and obtain a CE mark, which is needed for conformity in Europe.

Ready for delivery “This incubator’s chamber has been made using cardboard. It’s low-cost, disposable and possesses heating and cooling functionality,” adds Rao, as he hands over the encasement for inspection. “It looks like a pizza box!” one mentions. “Exactly, and it works like one too, it keeps the baby warm,” says Rao. Cardboard is a good thermal insulator. It maintains the warmth over a sustained period of time.

A well-regulated environment, in terms of temperature, is essential for a baby’s survival, especially for infants with lower-than-normal weight. This way, the baby can use all her metabolic energy for growth as opposed to regulating body temperature.

The disposable incubator also doubles up as a chamber for infection prevention and control, and keeps the baby safe from mosquitoes. “Neonatal incubators are a hotbed of infection and they are seldom properly cleaned, even at big hospitals,” explains Kumar. “By making sure that the chamber is disposable we are preventing reuse, thereby eliminating concerns about infections being acquired or spread,” he adds.

Work is on to add more features, including an integrated low-cost camera and weight sensors that can automatically report data via a cellular modem. This is done at user specified intervals so that human input is not required.

The team also feels that the device is scalable since it piggybacks on existing cellular networks and is powered by an off-grid solar rechargeable battery. “It can be used without electricity for up to eight hours a day,” says Rao.

Kangaroo care The incubator has a modular plug-and-play design. This means that the device can be placed right beside the mother, making it easier for her to access the baby, enabling kangaroo mother care (KMC).

“KMC is one of the most reliable ways to save pre-term and low-birth weight babies in high and low-income nations. This form of care involves teaching mothers and caregivers how to keep newborns warm through continuous skin-to-skin contact on the mother’s chest,” explains Rao. And in villages, mothers are frequently pressured to get back home as soon as possible. A device such as this would allow superior infant development in the critical first few weeks at the convenience of the patient owing to its portable design, he adds.

UMBC’s Govind was keen to have the design available to anyone to commercialise it. To ensure this, he obtained a provisional patent and got it released to him (by UMBC) and then let it expire. Now, it is available in the public domain. “The idea is to allow anyone to copy the design and not have any barriers to its use,” adds Venkatesan.

The prototype’ has been developed over three years using two seed grants provided by the US-based National Collegiate Inventors and Innovators Alliance (NCIIA) and Food and Drug Association (FDA). The next stage is to have the sensors integrated and validated in a field setting.

The target sale price of the system is $200 for the incubator (this can be considered as a fixed cost or an one-time investment on the part of the health-care centre, since it’s reusable), less than $10 for the disposable chamber and less than 20 cents for disposable bed liners.

"While in urban hi-tech hospitals, the cost of infant care would be in tens of thousands of rupees, in rural India, the medical centers have no facilities- typically a light bulb serves as a warmer,” says Rao.

This price point, they believe, is affordable enough to result in a high-volume, low-margin profitable venture. “Roughly ₹500 for the reusable chamber, that’s the cost of a large pizza,” one observes. Rao smiles in agreement.