Diagnosing anemia
should be this easy.

ToucHb - the non-invasive anemia diagnostic.

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What is anemia?
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.
Who gets anemia?

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.
The Anemia Cycle

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
Causes of Anemia
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
Treating Anemia
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
Why not simply give iron supplements to everyone as preventative medicine?
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

  1. World Health Organization / Centers for Disease Control and Prevention. Assessing the Iron Status of Populations. Geneva: World Health Organization, 2004.

  2. Rao, Shobha, et al. Social dimensions related to anaemia among women of childbearing age from rural India. Public Health Nutrition: 14(2), 365-372.

  3. Kalaivani, K. Prevalence & consequences of anaemia in pregnanacy. Department of Reproductive Biomedicine, National Institue of Health & Family Welfare, New Delhi India. Indian J Med Res 130, Nov 2009, pp 627-633. (http://icmr.nic.in/ijmr/2009/november/1125.pdf)

  4. United Nations Children's Fund, United Nations University, and World Health Organization. "Iron Deficiency Anaemia: Assessment, Prevention, and Control. A guide for programme managers." Geneva: World Health Organization, 2001.

  5. Scholl, Theresa O. “Iron status during pregnancy: setting the stage for mother and infant.” American Journal of Clinical Nutrition. 2005; 81(suppl). (http://www.ajcn.org/content/81/5/1218S.full.pdf+html)

Product Use Scenario
  1. Preparing for Home Visits

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    Accredited Social Health Activist (Asha) worker packs her Postnatal Care (PNC) bag in preparation for maternity checkups in local villages.
  2. Traveling to the Village

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    The Asha worker travels several kilometers to remote villages. With Biosense ToucHb, her PNC bag is lighter and more rugged, making her journey more comfortable and safe.
  3. Diagnosing the Patient with ToucHb

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    During the maternity checkups, the Asha worker meets with women in their homes to check on their health. It is easy for her to test for anemia because ToucHb does not require any needles, which the village women fear and view as taboo.
  4. Treating the Patient

    image
    The Asha worker will visit the woman at five points during and after pregnancy. She will use ToucHb to diagnose the severity of the anemia and then provide nutritional advice and supplements. In severe cases, she will provide a doctor referral.
Technical Specifications

Size Height 8.25 inches
Width 5 inches
Depth 3 inches
Wire Length 40 inches

Weight 33 oz (935 grams)

Finger Compatibility Finger diameter range 20 mm to 50 mm

Resolution Wide: increments of 1g between 1 to 10 g/dL
Fine: Increments of 0.1g between 6 to 8 g/dL

Power Source 2 AA Batteries (rechargeable or non-rechargeable)

Battery Life 3 weeks

In the box ToucHb brick
Cable
Finger Probe
2 AA Batteries
Instruction Manual

How It Works

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.
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Cultural Acceptability
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

  1. Garg, R. et al. “India Moves Towards Menstrual Hygiene: Subsidized Sanitary Napkins for Rural Adolescents – Issues and Challenges.” Maternal and Child Health Journal, 2011.

  2. Sigh S. A. and Dr. Siddharth G. Das. “Modern Blood Banking in India: A Study of Prathama Blood Centre.” S. K. Patel Institute of Management & Computer Studies, Sarva Vidyalaya Campus, Gandhinagar.

Awards
Winner of the Grand Prize in Global Health at the Global Social Entrepreneurship Competition 2010
Winner of the Sankalp Award for "Best Emerging Company in Healthcare" 2009
Winner of the Piramal Prize for democratizing healthcare in 2008
Quotes
With ToucHb, "[w]e 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

"Sahli...is not so accurate reading. She might find the color to be matching with 7.5 [g/dL], the other nurse might find the color to be matching with 6.5 [g/dL], because it is just...perception of the color."

- Doctor, discussing the current diagnostic method Asha workers use

"A non-invasive [solution] has to be better than Sahli and as good as hematology analyzers. If it appears to match the gold standard, then it will be accepted. We need a screening tool that doesn't treat 8s as 7s [g/dL]. There must be a way to calibrate the device because otherwise you are burdening the doctor with having to treat more patients."

- Doctor, on the need for a calibrated and accurate device
Our Team
Myshkin is co-founder and CEO of Biosense Technologies. He has worked at Mckinsey & Company as a business consultant. He has also been a researcher at MIT as part of the team that conceptualized and built the Copenhagen Wheel, demoed at the United Nations Climate Summit '09. Myshkin holds a PhD in Management Information Systems from the Indian Institute of Management, Calcutta and a B.Tech in Electrical Engineering from the National Institute of Technology, Bhopal. He is an Unreasonable Fellow '11 and a TED Fellow '12.
Abhishek is the CTO at Biosense and product lead on ToucHb. He has a background in biomedical engineering from IIT Bombay and a MBBS in internal medicine from T.N.Hospital. He is a fellow at the University of Washington and focuses on research and entrepreneurship on med tech targeted at the developing world. He is an Echoing Green Fellow, 2010.
Yogesh is co-founder and COO of Biosense. He holds a MBBS in internal medicine from T.N.Hospital Mumbai. He has a management background from the Shailesh J Mehta School of Management, IIT Bombay. Yogesh's other responsibilities at Biosense include co-ordination of clinical research and patent strategy.
Aman Midha, Creative Director
Aman is the design lead at Biosense and apart from technology and product development, also looks after the communications collateral. Having worked with the automotive industry at Tata Motors as an interior designer, Aman now looks forward to improving health outcomes in the developing world with appropriately designed medical devices. He holds a M.Des from IIT Delhi and a B.Tech in Mechanical Engineering from NIT Bhopal. Aman is an Echoing Green Fellow 2010.
Anand CV Mallaya, Engineering Lead
Anand leads product engineer at Biosense. He has an expertise in embedded development with microcontrollers. He also has dabbled in web programming with apache, mysql, php, javascript, HTML and is interested in semantic web technologies and AI web. Prior to joining Biosense, he was worked at Quodio Medical Devices and C-DAC in different R & D roles. He is a B.Tech from the University of Calicut.
Our Story

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.

Past and current collaborators, employees and interns
2012
Engineering and Design: Adnan R
Design and Usability: Fawn E, Maria H
Product and Branding: Ashley W, Niels J
Business and Strategy: Sandeep S
Website: Curly Bracket Design
2011
Engineering and Design: Shaakir M, Reshma S, Ishaan S, Pritesh S
Product and Branding: Mayank C
Business and Strategy: Amit T, Abhiraman V
2010
Engineering and Design: Rajesh Mane
2009
Engineering and Design: Vikas Y, Kanak M
Our Advisors
Professor Rakesh Basant
Chairperson, CIIE, Indian Institute of Management, Ahmedabad
Mr. Ram Vaidya
Regional Director, Medical Devices, Johnson & Johnson
Professor L. K. Das
IRD Fellow, India Institute of Technology Delhi
Dr. Darshan Nayak
Stanford India Biodesign Innovation Fellow