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Early detection of developmental delays and growth deviations is important as it enables early intervention
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In India, approximately 22 million children are affected by developmental delays that often go undetected or are detected late, at extensive cost to parents and irreversible damage to the child. In addition, 30% do not adhere to immunization schedules, 40% are malnourished, and an estimated 7% suffer from obesity. Growth and developmental issues, along with incomplete immunization, are the most common preventable causes of child morbidity and mortality. Early detection of developmental delays and growth deviations is important as it enables early intervention, which in turn ensures that parents and children suffer minimum physical and financial damage. Developmental interventions, especially, are most effective before the age of three years since the plasticity of neurons decreases with age.
Early detection of developmental delays depends on careful and continuous monitoring by paediatricians and/or parents. However, studies have shown that parents generally pay attention to selective milestones such as sitting, walking and speaking. While these milestones are important, focus on them alone is insufficient. The comprehensive developmental assessment requires attending to the social, fine motor and cognitive dimensions as well. Therefore, isolated focus on selective milestones is likely to delay the detection of developmental disorders. For detecting growth concerns, parents generally monitor their children’s weight, but the detection of problems depends upon identifying a trend, which requires continual monitoring and careful plotting of values. Finally, research has shown that timely reminders to parents increase the likelihood of completing immunization schedules.
Dr Neha Kumar of Georgia Tech and I are working on a mobile health (mHealth) platform called BabySteps, which can empower parents to track their baby’s development, growth and immunization. Our idea won first prize at a MedTech Jugaad-a-thon organized by CAMTech India, along with Glocal Healthcare and GE Healthcare, in July 2014. The project was also awarded CAMTech’s India Innovation Award offering support from USAID for one year toward development/commercialization of an innovative medical technology that can significantly improve health in low- and middle-income countries.
The increasing penetration of mobile phones across the world has been a trigger for innovators to develop mobile-based solutions for healthcare. Numerous applications are available that enable monitoring of chronic diseases and keep track of health parameters, among other things. However, behavioural change requires much more than technical and clinical appropriateness in isolation. It entails attending to the patient’s or target population’s concerns about specific health issues and patterns of conduct. The concept and design of the application BabySteps attempts to bridge the gap between technology and behavioural change by addressing the issue of engaging parents in their child’s development.
We began with a needs assessment exercise, in which we conducted a survey of Indian parents and interviews with paediatricians to identify challenges and opportunities in the current state of affairs. This provided validation of the need to equip parents with information and tools for monitoring growth, development, and immunization of their children. We then started iterative development of the product, working closely with a select set of trusted doctors, parents, and design/technology experts.
The product is based on a key insight that the progress paediatricians would like to monitor can be tracked using the milestones that parents record regularly, like “baby’s firsts" using a baby book. BabySteps attempts to integrate the natural emotional engagement of parents who record their child’s development in the form of a baby book and the clinical information that a paediatrician wants to monitor. This will ensure that parents not only remain informed and alert, but also are incentivized to input necessary information. While the parent is emotionally engaged in recording their child’s memories, BabySteps will non-intrusively monitor the child’s progress, gently nudging the parent to consult the doctor when the child falls behind.
The three proposed offerings of BabySteps are: a multimedia tool that records memories in photo, video, audio and note form—all in one place; a growth, development and immunization tracker that non-intrusively checks off milestones based on clinical best practices; and an avenue for reaching out to friends, support groups and. most importantly, paediatricians. Initially, the prototype aims to do the first two for now, since the parents’ survey and paediatricians inputs indicated these to be higher-priority items.
The user interface has been designed after conducting several iterations. The application empowers parents and enables paediatricians rather than substituting for clinical care. Hence, the application has been built on the basis of continual discussions with and taking timely feedback from paediatricians across India.
The design of the application takes into account contextual nuances by using India-specific norms, charts and values. The milestones selected are based on the Development Assessment Scales for Indian Infants (DASII), which is a standardized tool for evaluating the development of a child on multiple dimensions of motor and mental abilities. The selection of milestones was based on in-depth discussions with paediatricians as well as parents. The growth charts and the immunization schedule that is used in the application are the ones recommended by the Indian Academy of Paediatrics (IAP). The next phase of development will involve testing the prototype and getting the perspectives of paediatricians and parents on various offerings of the application. After incorporating the insights from our pilot testing, the final version will be available soon for circulation to a wider parental population for an extensive population-based study.
Our aim is to empower every Indian parent to track their child’s development, growth and immunization status. The initial feedback from parents, paediatricians and obstetricians has been quite encouraging. On the basis of discussions held with experts, we wish to incorporate multiple features in the application in the near future—for example, making it multilingual, more intuitive, and expanding the scope to include connectivity to paediatricians.
Rajesh Chandwani is a faculty member in the personnel and industrial relations area at IIMA. This article presents the author’s personal views and should not be construed to represent the institute’s position on the subject.
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