Health workers in a remote province high in the Peruvian Andes are trialling a revolutionary method to treat babies with jaundice – with nothing more than a colour-coded ruler, blood reader and carrycots.

Their goal is to screen, diagnose and treat jaundice in 12,000 newborns over the next two years in a country where 90% of the public health facilities lack the capability to adequately diagnose or treat it in newborns.

Jaundice is caused by a build up of bilirubin in the blood and in newborns is common – affecting 60% of all babies worldwide. However, left untreated, it can pose serious health concerns such as cerebral palsy and deafness. In Peru, the rates of jaundice-induced brain damage are 20 times higher than in wealthier countries.

“Jaundice is a serious public health issue here in Peru,” said Fernando Pérez Lastra, national director of non-profit development organisation Inmed Andes, which is launching the two-year project with the backing of Peru’s ministry of health.

“In 2016 and 2017, around 20,000 cases of jaundice were reported [nationwide], but in 2018 that figure went up to 31,000. It’s not clear if that jump was from better reporting or if there were simply more cases – but we need solutions. That’s why an intervention like this is so important and so necessary: we have to identify these cases before complications arise.”

Although the health workers’ new medical tools may sound basic, they are actually a combination of three highly sophisticated technologies – dubbed the “Bilikit” – which were developed specifically by Inmed and various partners for remote and low-resource regions like Peru’s central highlands.

A yellow-graded “Bili-ruler”, held up against the newborn’s nose, allows health workers to screen the infant’s jaundice levels; a handheld “Bilistick” loads a heel prick of blood on to a cartridge and measures bilirubin concentrations; and a portable, battery-capable ‘Bilihut’, shaped like a carrycot, provides the infant with high-intensity phototherapy.

The entire kit is the first complete jaundice management package of its kind. Elements have been previously trialled in Burundi, Cambodia, Ethiopia and India, but this is the first time all three technologies are being used together.

“Traditionally, a baby with neonatal jaundice in a remote area would have to travel long distances to receive adequate treatment and technology,” said neonatal specialist Dr Donna Brezinski, founder and CEO of Little Sparrows Technologies, which developed the Bilihut.

“Instead of the baby going to the facility, we’re bringing the equipment to the baby and facilitating diagnosis and treatment.”

Neonatal jaundice normally peaks in intensity during the first week of life and then self-resolves, with only 10% of newborns worldwide requiring medical intervention. But in areas like Junín, many mothers give birth at home, and those who give birth at hospital generally return home before symptoms appear. As a result, many neonatal jaundice cases are either dealt with very late, or in some cases, not at all.

Left untreated, severe neonatal jaundice can lead to kernicterus, serious brain damage that can result in cerebral palsy, blindness, deafness and death.

“Currently, a lot of the community health workers and health personnel know about jaundice but they don’t have a systematic way of identifying it,” said Kristin Callahan, Inmed’s director of international programmes, who is currently helping train health workers to identify symptoms.

“They might see a baby where it’s so yellow that they know for sure it’s jaundice and they then refer it to hospital. But only some hospitals have treatment facilities, with old-syle devices that take much longer to treat the infants. The Bilihut should cut that treatment time in half.”

Jaundice is caused by a build up of bilirubin in the blood, which causes yellowing in the eyes and skin. But estimating an infant’s jaundice level by eyesight alone can be problematic, said Brezinski.

“Jaundice can be very difficult to identify, particularly with darker-pigmented populations.

“But every single delay [in that child receiving treatment] might lead to a poor outcome such as neurological brain damage or a spectrum of disorders, like hearing loss or a speech delay, that wouldn’t be detected until they’re much older.”

Over the next two years, 40 community health workers will travel door-to-door in 25 regions across Peru, screening for jaundice.

Where necessary, they will refer newborns for blood tests in nearby hospitals and health centres, and subsequent treatment in the phototherapy cots, which can be set up next to mothers’ beds.

Health worker Jusely Susan Huachiva Coporras, 27, is undergoing the current Bilikit training and wants to share her experience and knowledge of jaundice with other mothers.

“My two children suffered from jaundice, and the first had to be hospitalised and undergo phototherapy,” she says.

“I really believe in this project, because I don’t want any newborn to have to go through what mine did.”