Two years ago, Stella Kimbi lost her first baby. "At 28 weeks of my pregnancy, I started bleeding and was taken to the hospital. I delivered a small baby and was told the baby had to remain in an incubator. At the health center, there was no incubator, so my husband was advised to take the baby to the Cite Vert Hospital, but there was no available incubator there either. When we got to the Yaoundé Central Hospital, the doctor declared the baby dead, I was devastated," Kimbi recalls.
Globally, 2.4 million babies died in the first month of life in 2020. Given the impact of the COVID-19 outbreak in 2020, it must be noted that these deaths are not a deviation from the expected mortality of this age group. At 27 deaths per 1000 live births, Sub-Saharan Africa has the highest neonatal mortality rate in the world and accounts for 43% of the global neonatal mortality rate. The 2018 Demographic and Health Survey (DHS) reveals that the neonatal mortality rate in Cameroon is 48 deaths per 1000 live births.
Out of the ten regions in Cameroon, the Far North, Adamawa, Northwest, and East regions have the highest neonatal mortality rates. "These are areas where maternal and child health indicators are poorest," says Dr Anicet Désiré Mintop, Director of the National Multi-sectoral Programme to Combat Maternal, New-born, and Child Mortality. He adds that preterm births account for 8.5% of infant deaths in the country. One of the reasons contributing to the high incidence of infant mortality in Cameroon, is the acute shortage of incubators, with just 100 in the entire country of over 28 million people.
Mintop believes that 15,000 preterm infant deaths could be prevented each year, if health facilities in Cameroon had enough incubators and an adequate health workforce. However, he sees a glimmer of hope as solar-powered incubators are now being produced locally.
Addressing the incubator shortage
A news report on a mother who lost her quadruplets at the Yaoundé Central Hospital in Cameroon's capital city, Yaoundé, due to the lack of neonatal incubators back in 2016, was the trigger for Serge Armel Njidjou to search for a solution to the neonatal deaths. Founder of the University Agency for Innovation (AUI) Njidjou joined the fight to reduce Cameroon's neonatal mortality rates by building a neonatal incubator model using materials sourced locally.
His prototype incubator model won the President Biya Prize for scientific innovation in 2018. While funds from Orange Africa, the Middle East digital challenge and the French Development Agency (AFD) prizes provided the financial boost needed to scale production.
An earlier model of the incubator ran on electricity with a battery backup system. However, a hybrid model that can either be charged with solar panels or with electricity, was later designed. This upgrade was developed to address the energy problems commonly experienced in Cameroon and across many countries in Africa.
The incubators are fitted with an inbuilt camera connected to a smartphone. This means that the doctor, mother and other assigned health workers can monitor the baby remotely. Engineers can run remote checks and detect any breakdowns. They are also alerted via their smartphones when any malfunction occurs.
Once installed in the hospital, the doctors can set the temperature according to each baby's weight and, can lower or increase the temperature to suit their needs. With a built-in phototherapy system, the incubators also treat jaundice -- a yellow pigment of red blood cells.
In collaboration with the National Multi-sectoral Programme to Combat Maternal, New-born and Child Mortality, a group of scientists carried out electric functionality and bio-safety tests on the incubator to ensure its workability and safety. In 2019, Manaouda Malachie, Cameroon's Health Minister granted official approval for the use of the incubator. He further chaired a gala in 2021 to raise funds to purchase incubators for public hospitals, giving it a government stamp of approval and assuaging the fears of those still doubting its functionality.
The solar-powered interactive incubator is sold for FCFA 2.8 million ($4,544).
A chance of survival
So far, AUI has fabricated 35 incubators, some of which are being used in facilities like the Penka Michel Hospital, the regional hospital in Cameroon's West region; the African Genesic Centre in Yaounde-Center Region; the Garoua regional, the Bafoussam Regional Hospital and Protestant hospitals in Cameroon's North region.
The African Genesic Health Centre in downtown Yaoundé, takes delivery of about 60 babies every month, about 10 of whom are often preterm. Ikouba Marthe, head of the Neonatal Unit says that "babies of 28 to 30 weeks are a risky group. It Is risky to transport a low-weight baby from one area to another, they may get infected and eventually die. The biggest difficulty was to have access to conventional incubators, which are very expensive and when faulty, technicians and spare parts are not available, because they are fabricated abroad," she says.
In 2021, the health centre acquired two interactive incubators and in 2022, the records show that about 45 babies have been saved, thanks to having incubators readily available, says Ikouba. She is happy with the incubator as "one key advantage is that with the in-built camera, mothers see their babies and ask questions, therefore reducing the stress of not being close to them". Another advantage for her is the fact that when there is an issue with any of the incubators, repairs are carried out immediately. "The UAI lab sometimes lends us incubators when there is high demand," she adds.
Pauline Njie, a mother waiting to check on her baby at the Genesic Health Centre recounts how scared she was of losing her baby. She had gone into early labour and at the first health canter there was no incubator. "I was lucky that a call to the Genesic Health Centre confirmed the availability of an incubator. I was transported there, had my baby. She was low weight and was put in the incubator immediately. My baby is alive today thanks to the incubator and I understand it is made in Cameroon."
The Bafoussam Regional Hospital, a public hospital in the West region of Cameroon purchased one solar-powered incubator in 2021. According to Dr. Gisele Ndjindam, a paediatrician at the hospital, the locally fabricated incubator works as well as an imported incubator. "The machine was tested, and it works well and can be used in case there is a serious electric power outage," she says adding that, "It is difficult to count the number of babies saved since we have other incubators."
Barriers to uptake
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Njidjou says a major challenge for him was the slow acceptance of the locally made incubator. Despite the fact that it passed the functionality and bio safety test, it was difficult to convince hospital staff to use the equipment. "Often many people are sceptical of locally made equipment and do not even want to try it out," he adds. The support provided by the government is helping to drive acceptance.
In Cameroon, an imported incubator sells for FCFA 6 million ($9,738) while the locally made incubator is sold for FCFA 2.8 million ($4,544). Although the locally made machine costs less than its imported counterpart, cost is still a huge barrier for hospitals wishing to acquire the equipment. This is especially true for hospitals in rural and remote areas where access to electricity is a major challenge.
In areas with heavy rainfall, particularly parts of the Southwest and Northwest regions, adequate sunlight to power the incubators may still be a challenge. But Njidjou and his engineers are working on a solution to make the incubators available everywhere in the country. This is in line with the AUI team's long term goal to have their product in all public and private hospitals in Cameroon.
African solutions to African problems
It is no secret that Africa has the intellectual and scientific capacity to develop technologies tailored to tackle its health challenges. At the just concluded 2nd Conference on Public Health in Africa (CPHIA), there was a call to support Research and Development (R&D), as well as local manufacturing of medical products in Africa. With the right collaborations, political will and adequate funding, an enabling environment can be created to produce more innovative and low-cost technological solutions to Africa's pressing health challenges.
