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Whether high-, low- or medium-tech, these inventions are just right

By Maryalice Yakutchik

A Turtle to the Rescue

There’s water everywhere in Bangladesh where houses commonly are built on excavated mounds of earth and consequently surrounded by ditches and ponds. As a result, 17,000 kids drown here annually (46 every day) making it a leading cause of death in children ages 1 to 4.

The obvious solution—erecting barriers around the water—simply isn’t feasible. But perhaps the Safety Turtle is.

Marketed to swimming pool owners in the U.S. and Canada to protect pets and children, the Safety Turtle is a personal immersion alarm with a wireless base unit that blares a warning when the device (shaped like a small plastic turtle) hits water. The turtle can be affixed easily to a toddler’s wrist, says Adnan Ali Hyder, MD, PhD ’98, MPH ’93, an associate professor in International Health who directs the International Injury Research Unit.

He and Alain Labrique, PhD ’07, MHS ’99, MS, assistant professor in International Health, are pilot testing the device in the field—soggy as it is—to find out if it will work in a monsoon climate as well as be culturally appropriate and socially acceptable. The research is supported by a JHSPH Faculty Innovation Award to Labrique, who has worked in rural Bangladesh for more than a decade.

Although the $150 kit is prohibitively priced for use by most Bangladeshis, the researchers think one solution might be to divvy up the cost between a half dozen families living together in a community; they could share a base unit connected to a dozen or more turtle devices, each of which would cost relatively little. “We’re targeting this as a supervision aid for parents of toddlers,” Hyder says. “If they are busy working and cooking and an alarm goes off, it will alert an entire community to look for the children and see who’s in the water.”

Driving Down Teen Collisions

Compelled by chilling crash statistics and inspired by watching his son play Grand Prix video games, David M. Bishai, MD, PhD, MPH, set out with a grant from the Center for Injury Research and Policy (CIRP) to improve something that’s largely been neglected for decades: driver’s education for teens.

“Hardly anyone’s examining what young drivers need to know to be safe,” says Bishai, a professor in Population, Family and Reproductive Health. While yawn-inspiring old-school driver’s ed may be of questionable value, he contends that an engaging program employing innovative software that emphasizes contemporary hazard-recognition content could, in fact, make a life-and-death difference in the same way that graduated licensing has. His aim: to create an interactive experience that teaches teens to anticipate road hazards.

With Hopkins colleague Sara Johnson, PhD ’05, MPH ’01, and Maria Schultheis, PhD, of Drexel University, Bishai is testing the validity of a Digital Mediaworks driving simulator. The team has tested 10 subjects so far, correlating measures of driving performance in the lab with measures of attention, risk-taking and intelligence. Bishai’s goal now is to compare the performances of 100 16- to 18-year-old novices to more experienced drivers in the context of routine driving as well as with added stresses such as phones ringing.

As the simulator measures each subject’s specific competencies, it also gives researchers insight into the teen brain.

“If we show the simulator can differentiate between good and bad driving, and inexperienced and experienced drivers,” he says, “then we would have an ‘in virtuo’ model of the most lethal threat to teen health—driving.”

All Done with DUI

Imagine a smart steering wheel that could sense by the mere touch of a driver’s hand if he’s had one too many. This is the next generation of alcohol-sensing interlock technology: Automatically activated and pre-market installed, it would prevent a car from operating if a driver is beyond a pre-set limit, even if he (mistakenly) thinks he’s safe to hit the road.

A steering wheel capable of calculating a driver’s blood-alcohol concentration based on the chemical properties of his skin may seem futuristic. But it is one example of technology being applied to a new class of alcohol detection systems that are already in research and development by car manufacturers, says Shannon Frattaroli, PhD ’99, MPH ’94, an assistant professor of Health Policy and Management with CIRP.

“It’ll no longer be a matter of figuring out strategies to discourage people from drinking and driving,” she says. “Now, we can imagine a time when drinking and driving and all the deaths, injuries and mayhem associated with it will just not be possible.”

Injury prevention research has borne out the fact that passive interventions—those requiring no action on the part of users—are very effective, Frattaroli says. Think airbags, for instance.

What society decides to do with this technology once it’s available could have huge implications for public health. CIRP faculty members are monitoring the development of alcohol- sensing technologies and the policy options under consideration for advancing their application. “If we can end the devastation caused by drinking and driving—and it seems possible in the not-too-distant future—that’ll be an amazing advancement,” Frattaroli says.

Baby's First Photos

Because gestational age is a critical indicator of newborn health, Parul Christian, DrPH ’96, MSc, MPH ’92, and colleagues enlisted 500 pregnant women in rural Bangladesh in a study that compared the gold standard for determining precisely how long a baby spends in the womb—ultrasound—with “last menstrual recall.”

The recall technique is shaky at best, particularly in the setting where Christian has spent a dozen years conducting research. It depends not only on whether a woman reliably recalls the first day of her last menstrual period—which may in turn depend on her level of literacy—but also whether her cycles are regular.

Neither assumptions nor the inherent uncertainty of memory bodes well for taking the critical first step in bringing about lifesaving policy changes: gathering good, accurate data.

“In public health we’re interested in trying to figure out the factors that lead to preterm birth, which is associated with a high risk of mortality and morbidity,” Christian says.

Having purchased a portable Sonosite Titan ultrasound device for $14,000, Christian and Alison Gernand, PhD ’11, MPH, RD, assembled a team in the JiVitA field site in rural Bangladesh, where 90 percent of women deliver at home.

Trained technicians assessed women who visited a study clinic, recording fetal crown-rump lengths on sonograms to estimate gestational age at birth. A sample of the sonograms and measurements were reviewed for quality control by collaborator Frank Witter, MD, of the Johns Hopkins School of Medicine.

“This is an important technology to use in populations where we don’t really know the burden of preterm birth, or may have only an inaccurate estimate of its magnitude,” Christian says.

“Encouraging results from our study, which is still in the works, should motivate people to use ultrasound for gestational age assessment in such settings.”

The portable ultrasound technology also allowed the team to better estimate expected dates of delivery for the women who, as part of the same research effort, agreed to be visited when they went into a labor by a team of nurses for the collection of cord blood and placentas; these will be analyzed to assess the impact of micronutrient supplementation during pregnancy on nutrient transfer to the fetus, and placental and birth size.

Research Made Simple

Alain Labrique’s office houses a trove of technological treasures that support research from Kenya to Bangladesh. Constructed largely onsite by local people, the inexpensive solutions often stand up to gold-standard tools. “If you can think it up and draw it on the back of a napkin, it can be sitting in your office by the next afternoon,” says Labrique. Here are three of his favorite “low-cost threshold” technologies.

The Cheap Dessicant

When does an ages-old food staple that’s ubiquitous as rain in the tropics become a new technology? When puffed rice serves as a low-cost desiccant to keep vitamins dry and fungus free.

“We need to distribute vitamin A gel caps across a huge area plagued by monsoon humidity, and can’t give out supplements covered in mold,” says Labrique, PhD ’07, MHS ’99, MS, an assistant professor in International Health. “First, we brought in all manner of desiccant packs and vials. When you multiply those by 600 villages, it’s a nightmare in terms of added cost. A Bangladeshi field worker told us that when they want to keep sweets or edibles dry, they puff some rice, fill a jar with it and stick whatever they want to keep dry inside.”

Baby’s First Square

Birth weight reflects heavily on infant health in environments like rural Bangladesh, where most births occur at home and mortality peaks in the first few hours of life.

“The Baby Square was our first effort to attempt to empower families themselves with a simple tool to assess length as a proxy of birth weight,” Labrique says.

A 45-centimeter rectangular plastic mat with matha (head) and paa (foot) marked on it, the Baby Square costs about 15 cents, Labrique says. The researchers want to know just one thing: Does the baby fit? The Baby Square affords researchers reliable data and helps families recognize suboptimal birth size, which could prompt them to seek medical care.

Sheet Metal Pill Counter

How do you help 850 field workers whose job is to visit remote Bangladeshi villages and hand out weekly supplements and micronutrients—without actually handling the pills—to 68,000 women over the course of five years?

If you’re Labrique, you consult with your in-country team who, after fashioning a prototype pill dispenser out of cardboard, hands it over to a guy in the village who has lots of sheet metal lying around. In no time, you are presented with a shiny pill counting tray/dispenser made of local materials that perfectly fits your research paradigm.

“It’s built for accuracy and efficiency, and it conveys respect for our study subjects who see workers using handheld trays and clean counting sticks to make sure that the pills are not contaminated by their touch,” Labrique says.

Ring Around the HIV

Male circumcision is proven not only to protect men against HIV, reducing their risk up to 60 percent, but also to benefit women by cutting their risk for infections other than HIV. Still, efforts to scale up the procedure where it’s most needed have lagged.

Now, new alternatives could be the key to making male circumcision more widely available, affordable and acceptable, says Ronald Gray, MD, MSc, a professor of Epidemiology who has conducted NIH-funded trials of male circumcision for HIV prevention in rural Uganda.

Gray and his team are evaluating two devices—the Shang Ring and the PrePex—that address the major constraints thwarting progress in places ill-equipped to handle the need and demand for male circumcision.

The main components of the plastic devices are inner and outer rings that a minimally skilled health care practitioner can apply in minutes, simply by placing the foreskin between the rings. The Shang ring is applied under local anesthesia, and the foreskin removed surgically. The device remains in place and is removed after one week. The PrePex does not require anesthesia; it remains in place for a week during which the foreskin tissue dies naturally from lack of blood supply and is removed with the device. The devices cost between $15 and $20—less than half of a conventional male circumcision in rural Uganda.

“In men, circumcision reduces their HIV risk by removing target cells used by the virus, and possibly by changing the bacterial flora on the penis,” Gray explains. “If these devices work, they could greatly expand our ability to provide circumcision services, primarily in Africa.”

Saving Lives One Drop at a Time

by Ted Alcorn, MHS ’10

The impact that technology can have on public health can be as simple as the difference between clean and dirty water, but can be as profound as the difference between clean and dirty water.

Adelina Huo carried this lesson back from Ghana last January. Huo, an undergraduate public health major, journeyed there with other students on a fellowship with the NGO Community Water Solutions. She was drawn to the issues of poor water and sanitation, deceptively simple problems with huge ramifications.

The impact that technology can have on public health can be as simple as the difference between clean and dirty water but can be as profound as the difference between clean and dirty water.

“Everyone needs water to survive, and the fact that some people don’t [have clean water] simply because they’re born somewhere that doesn’t have it, just seems so unfair to me,” Huo explains. “Why can’t we do our best to somehow change that?”

Huo and her three co-fellows, who together raised the $10,000 for the costs of their trip and the project itself, spent nearly a month working with a community in northern Ghana to establish a water-treatment center for filtering and chlorinating water. The center relies on the simple, low-cost technologies of alum and chlorine to sterilize the water.

In Huo’s eyes, a pivotal challenge was implementing the technology in a setting vastly different from where it was designed and introducing new behaviors into well-worn patterns of daily life. “Any technology or solution that requires people to completely change their lives is probably not going to work that well,” she explains, which is why Community Water Solutions and others design projects with “appropriate technology” that correspond to the communities that need them.

Huo came back to Baltimore resolved to learn as much as she could about technology and public health, and ultimately chose to add a minor to her degree: engineering for sustainable development. “I hope to be a sort of middle man between public health and technology, and figure out how to integrate it more fully into communities and make it sustainable,” she says.

The poverty she saw in Ghana also moderated her expectations about impact; after all, the community she had worked in now has clean water but still lacks a school.

But accepting this does nothing to undermine her hopes. “We really only solved one small thing, and there are so many other things to do,” she says. “But I don’t see that as discouraging. That just makes me want to do more.”