Meet the Team.

Anemia is a nutritional deficiency that has become one of the most common and intractable public health concerns in the world.¹ According to the World Health Organization, there are approximately 2 billion people with the disease. Anemia is defined as a decrease in the number of red blood cells or a less than normal quantity of hemoglobin, the iron-rich molecule that transports oxygen from the lungs to the rest of the body. This deficiency weakens the blood's ability to clot, increasing the risk of postpartum hemorrhage in mothers and the risk of congestive heart failure in general. Low levels of hemoglobin impair the physical and mental development of children.

Nutritional anemia occurs in 52% of pregnant women across India. Nutritional anemia is the most common cause of infant prematurity and low birth weight.² For this reason, Biosense is partnering with private, government, and non-government organizations to deploy ToucHb through Accredited Social Health Activist (Asha) workers that treat this high risk population of women and children.

Anemia is a cyclical disease. Nutritional anemia accumulates throughout the life of a woman and is passed on to her children through low birth weight.² According to the Indian Journal of Medicine, low hemoglobin levels double the rate of low birth weight infants and more than double the perinatal mortality rate. Low birth weight infants do not grow to full maturity and in turn, give birth to more low weight children. Thus, maternal anemia contributes to an intergenerational cycle of poor health and mortality.³

Iron deficiency is the most common cause of anemia, but other causes include inflammation, micronutrient deficiencies, and genetically inherited traits. Infections common to the developing world, such as malaria, schistosomiasis, and hookworm infestation, are frequently the cause of anemia due to their effect of direct blood loss.⁴

There are two forms of treatment for nutritional anemia: iron tablets and injections. Both are widely available and subsidized in India. The main concern is timely diagnosis, which is why Biosense focuses on enabling safe, reliable, needle-free diagnosis. Iron supplements are the most common strategy currently used to control iron deficiency in developing countries. This is likely to remain the case until either significant improvements are made in the diets of entire populations or food fortification is achieved.⁴

According to the American Journal of Clinical Nutrition, iron supplements improve pregnancy outcomes when a mother is iron deficient; however, iron pills can increase risk of gestational diabetes and other birth complications if given to those women who already have sufficient iron stores.⁵

The ToucHb technology is based on the idea that light is transmitted, absorbed, and reflected through a person's finger in different ways depending on their blood hemoglobin levels (Hb). By tracking the light intensity for these three waveforms across different wavelengths of light, it is possible to capture a sensitive and specific signature for various levels of anemia.

ToucHb provides a wide resolution and finer resolution for health care workers to triage patient care. Wide resolution increments (of 1g between 1 to 10 g/dL Hb) allow quick assessment of who is at risk. The finer resolution increments (of 0.1g between 6 to 8 g/dL Hb) determine the type of care for patients in critical anemic condition.

Many Asha workers agree that convincing the patient to take an anemia diagnostic test is the hardest part of the screening process. In the village, family beliefs and social taboos lead to fear of needles and reluctance to give blood during pregnancy and post-delivery.^{1, 2} Particularly during a post-natal care visit, most midwives are not allowed to takes blood due to various village beliefs around birth. The women have had their child and are not open to invasive medical intervention.

By using ToucHb, Asha workers no longer need to spend time convincing patients to take the subjective Sahli test. Villagers perceive ToucHb as non-threatening.

With ToucHb, "we won't have to do so many other things like getting a bowl of water. The test tube won't have to be washed. The main thing is it will save time. Plus, we won't have to carry along the instruments that we have to carry at present...and the patient too will feel good if we don't take out blood. It is a good method--without drawing blood."

- Asha worker, upon using ToucHb

BBC News April 2012: Device to fight anaemia in India about to go on sale

TED Conference February 2012: Myshkin Ingawale: A blood test without bleeding

In 2007, Abhishek visited a village that was nearly 20 kilometers away from the nearest Primary Health Centre (PHC). Many of the women in the village were anemic but due to inaccessibility and lack of roads, it was impossible for them to travel to the PHC to get their blood samples tested. Despite being severely anemic, the women failed to recognize their own signs of being anemic, and did not feel sick enough to justify a trip to the PHC. Many did not consider a trip to the PHC worthwhile since it would mean losing their daily wages.

It was clear that these anemic women would end up risking not only their own lives but also their infants' due to complications during pregnancy, primarily because the existing healthcare system failed to identify or diagnose their anemia until it was too late.

So if these women were unable to walk to the PHC, we thought, why can't an Asha worker simply deliver a comfortable, reliable diagnostic directly to the village? That's where the compliance of the existing tools was low. We learned from a health worker with the National Malaria Control Program that the rural population failed to cooperate in providing blood samples to village health workers because there was no perception of being "sick" and villagers held taboos against giving blood.

The immediate solution appeared to be as simple as distributing nutritional supplements to all. However, after putting in a little more thought into it and discussing the idea with Yogesh and a few friends, we questioned whether a pulse-oximeter could determine hemoglobin levels. With prior experience in a bionic arm project, Abhishek was comfortable with electronic components... And that is when he began tinkering in his dorm room and started to develop a hemoglobin-o-meter inspired by pulse oximeter technology.

Together with a few friends, he got short listed for the IIT Techfest 2008, where the team Anaemedia was awarded the 2nd prize. The prize money was reinvested to improve the prototype. Anaemedia continued to participate in various competitions, becoming more refined each time.

The turning point came when Anaemedia became the runners-up at the Piramal Prize and were awarded incubation at the Centre for Innovation Incubation and Entrepreneurship, Indian Institute of Management, Ahmedabad.

In December 2008, Anaemedia was reincarnated as Biosense Technologies Private Limited.