The DHT-Lab maintains a rigorous, but small fundamental research effort. Undergraduate and graduate students can get involved in projects, work on graduation theses and independent studies through the DHT-Lab.
Currently there are two research projects in the DHT-Lab.
Much of the laboratory and medical equipment in resource poor settings is out of service. The most commonly cited reasons are 1) a lack of spare parts and 2) a lack of highly trained technicians. However, there is little data to support these hypotheses, or to generate evidence-based solutions to the problem. We studied 2849 equipment repair requests (of which 2529 were out of service medical equipment) from 60 resource poor hospitals located in eleven nations in Africa, Europe, Asia and Central America. A total of 1821 pieces of medical equipment were placed back into service, or 72%, without requiring the use of imported spare parts. We found that six domains of knowledge were required to accomplish 99% of the repairs: electrical (18%), mechanical (18%), power supply (14%), plumbing (19%), motors (5%) and installation or user training (25%). A further analysis of the domains shows that 66% of the out of service equipment was placed back into service using only 107 skills covering basic knowledge in each domain; far less knowledge than that required of a biomedical engineer or biomedical engineering technician. We introduced the concept of an evidence-based curriculum for a biomedical technician’s assistant (BTA).
Since its introduction, the BTA curriculum has been offered in Rwanda and Ghana. It will probably soon be deployed in Cambodia. In Rwanda, the curriculum has been shown to reduce out of service equipment by up to 40%. We are actively researching the impact of this curriculum on health and heatlhcare.
Prevention of Transmission of HIV from Mother to Child
The transmission of HIV from mother to child during the birthing process can be largely prevented by drugs such as Nevirapine (NVP). But, the child must receive this anti-retroviral within 72 hours of birth to be effective, and preferably within 24 hours. In Sub-Saharan Africa, many clinics have the drug, but a large percentage of mothers deliver at home. This leaves millions of children at risk of becoming HIV+ during the birthing process. Normally, it is not possible to provide NVP to the mothers months before delivery because the drug quickly loses potency once placed in a syringe, the most common delivery package. The Pratt School of Engineering at Duke University has developed a new packaging system that extends the life of the NVP and AZT by up to tweleve months.
The device is called the Pratt Pouch and it has received wide acclaim, including recognition from WHO and USAID. Clinical trials, hopefully showing fewer children becoming HIV+, are expected to begin in 2013.
Hypertension is a growing burden to people in the developing world. This project seeks to create a simple device that can be used by minimally trained healthcare workers to screen large populations for hypertension. This is accomplished through the comparison of the patient’s systolic pressure to a target pressure. If the patient has systolic pressure below this target pressure, the patient is said to have a healthy blood pressure, while if above this target pressure the patient is then a candidate for further screeening for hypertension. With the application of this device in rural clinics in low-resource areas, this device could save millions of lives.