How a Bangladeshi doctor used a shampoo bottle to save babies from pneumonia

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World Pneumonia Day (November 12) was established to raise awareness about the lung disease that is the leading threat to child health and survival. According to UNICEF and the World Health Organization (WHO), a child dies every 20 seconds due to severe pneumonia.

Pneumonia can be caused by bacterial or viral infections and can affect children and families everywhere. But the highest incidence of child pneumonia deaths occurs in South-Asia and sub-Saharan Africa.

This day also highlights the urgent necessity for devising impactful measures to combat pneumonia.

Challenges in pneumonia prevention

To prevent bacterial pneumonia, vaccination against the two main causative agents, Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib), are the current most efficacious means of protection for the individual as well as the community.

However, many developing countries have low immunization rates and may face challenges in implementing prevention strategies to combat pneumonia. Additionally, delays in treatment and diagnosis drastically alter the prognosis of the disease.

There is hence a need for raising awareness, and develop affordable treatment strategies that ensure improved survival outcomes within limited resource settings.

It was in this quest that Dr. Jobayer Chisti, from Bangladesh, developed a low-cost innovative device using a discarded shampoo bottle, which could save thousands of infants’ lives, according to BBC news.

Dr. Chisti was an intern at the pediatric department of the Sylhet Medical College Hospital in 1996, when he first saw infants succumb to the disease.

“Three children died in front of my eyes. Nothing was working,” said Dr. Chisti in a BBC Innovators video.

“I was so helpless that I cried that night. Then, I promised myself that night that I would do something in my life to curb this. But I didn’t know that day, that night, how it could be done.”

Treatment for pneumonia

Lung infections by bacterial or viral pneumonia cause build-up of fluids in the air sacs of the lungs. This reduces their intake of oxygen (hypoxemia) and results in acute respiratory stress syndrome in case of severe infection. Standard treatment for pneumonia involves administering antibiotics, and low-flow oxygen therapy.

And yet, despite the availability of these treatment strategies in developing countries, mortality rates for infants with severe pneumonia are very high. More sophisticated ventilator systems are used in developed countries to treat acute respiratory distress, but these are expensive and require trained staff to operate them.

The ventilator system can be operated to prevent the infected lungs from collapsing, by applying a continuous positive airway pressure (CPAP).

Innovation from limited resources

Dr. Chisti adapted the CPAP system that he had once observed in Australia, to develop a simpler bubble CPAP device at the Dhaka Hospital of the International Centre for Diarrhoeal Diseases Control in Bangladesh.

He made the device from a water-filled shampoo bottle, with a plastic tubing fitted and sealed into it.

“The children inhale oxygen from a tank and exhale through a tube which is inserted into a bottle of water producing bubbles in the water,” Dr Chisti explained to the BBC.
Bubbles are created in the water bottle, which exert a backpressure and keeps the lungs from collapsing, thereby increasing oxygen intake.
“We tested it on four or five patients at random. We saw a significant improvement within a few hours,” said Dr. Chisti.

Bubble CPAP study

For two years, Dr. Chisti and his team from Icddr,b and the Centre for International Child Health at the University of Melbourne, studied the efficacy of the bubble CPAP therapy in children with severe pneumonia, under the age of five. 225 children were treated with oxygen therapy by either bubble CPAP, low-flow oxygen therapy or high-flow oxygen therapy.

Children given oxygen therapy by bubble CPAP showed significantly improved outcome than low-flow oxygen therapy.

The results were published in The Lancet, in 2015. The trials were stopped early at the time due to higher mortality in the low-flow oxygen group. The authors acknowledge that further research may need to be done to compare bubble CPAP with high-flow oxygen therapy.

“Icddr,b’s study is the first in a developing country to trial the effectiveness of a cheaper version of bubble CPAP at reducing mortality and treatment failure for the children under five with severe pneumonia,” said Dr Chisti to the Daily Star.

Around 600 children have benefited from the device, reports the BBC. Dr. Chisti wants every hospital in developing countries to have the CPAP device available to them.

The higher efficiency of the therapy, combined with the affordability and simple operation of the device, makes for a truly remarkable innovation.

Source: BBC News