Thermocol boxes save neo-natal lives in tribal districts

Rita Dutta - Mumbai

Though it may appear unusual, thermocol boxes have come handy as a cheap alternative for expensive incubators for the Maharashtra government.

A baby sleeps in a thermocol incubator; Inset: Dr S R Daga

Low birth weight (below 2.5 kg), premature babies can be protected from hypothermia (body temperature below 96 degree F or 36 degree C) by placing them in ventilated thermocol boxes.

The government is using this novel method for its 15 tribal districts under the intensified neo-natal care programme and more than 14,000 thermocol boxes have been distributed recently.

According to experts, more than 80 per cent low birth weight babies face the threat of hypothermia. In the tribal districts of Maharashtra, around 40 per cent of the deaths within one month of birth is because of hypothermia. More than 90 per cent of the infant deaths occur at home even with the assistance of traditional birth attendants (TBAs). Said Dr V M Joshi, assistant director, health and family welfare, government of Maharashtra, "The innovative device of thermocol box helps check the death of infants which escalates during winter in the tribal districts in the absence of any provision to keep the baby warm." The thermocol boxes chosen for this purpose measure 50 cm by 36 cm by 25 cm, weighs 500 gm and are 2.4 cms thick. The lid of the thermocol box is kept closed and the baby is able to breathe because of the four holes in the walls which function as the ventilators.

Said Dr M R Jagtap, assistant director, in charge of tribal health, government of Maharashtra, "The boxes are being distributed free by the district health officials to the officials of primary healthcare centres (PHCs), who are handing it over to the anganwadi workers, midwives, pada sewaks and nurses so that it can be used for home-based delivery." The objective is to use such boxes at home and not at hospitals as more than 90 per cent of the deliveries take place at home in the tribal districts.

The government decided to launch this programme in the 15 tribal districts after the success of the pilot project in the Ganjad Primary Health Centre of Dahanu taluka of Thane district, where it was implemented without extra manpower and with nominal monetary investment at home and hospital level.

The pilot project showed a 75 per cent reduction in deaths among babies weighing 2.1 to 2.5 kg, 50 per cent reduction in deaths among babies weighing 1.6 to 2 kg, 33 per cent reduction in deaths among babies weighing 1.5 kg and less after the usage of thermocol incubator.

The brain behind this unique concept is Dr S R Daga, associate professor of paediatrics at Cama hospital, who introduced these thermocol boxes way back in 1983 in JJ hospital and proposed the same to the government. Says Dr Daga,"I saw thermocol boxes being used for transporting vaccines and it struck me as to why it could not be used as a substitute for an incubator."

Initially, Dr Daga used the boxes for transporting infants from the ward to the X-Ray department and from one hospital to the other, before he started recommending it to patients for home use. "Thermocol has good insulation properties and low thermal conductivity. It is chemically inert and is resistant to bacterial growth," informs Dr Daga. The box has good shelf-life and can be used successively for three to four babies as the boxes can be cleaned with soap and water.

Thermocol being cheap, the Mumbai-based JJ and Cama hospitals are using these boxes extensively in their Neo Natal Intensive Care Units. Says Dr Bela Verma, paeditrician, Cama hospital, "An indigenous incubator costs between Rs 50,000 and Rs 60,000 and an imported one costs Rs 3 to Rs 4 lakh. Considering the fact that an incubator can be used only for one baby, it is a big financial burden on the hospital to buy incubators."

The hospitals are asking patients to buy these boxes to be used at home at a nominal price of Rs 150 from the market and facilitate such boxs for the poor patients gratis. "We get referrals from roadside, where there is no provision to keep the babies germ-free. These boxes now are helping to save the lives of these road-side infants," informs Dr Verma.

To propagate this innovative method, the government has started training TBAs of these tribal districts. The government has earmarked Cama hospital to train the nurses associated with PHCs, who would in turn train the TBAs as how these boxes should be used.