Congratulations to Firefly, who won the Pitch Your Prototype competition at World Maker Faire in New York City this week. The Firefly bili light is a beautiful design that they have obviously worked long and hard to achieve. It’s great to see the problem of neonatal hyperbilirubinemia in the Developing World getting the attention it deserves.
Most fascinating to me, though, were the statistics listed in the article:
[...] every year 5.7 million jaundiced newborns in South Asia and Africa do not receive any phototherapy.
I assume this quote was supplied by the good folks at Firefly. It was misquoted in the Maker Pro article (which left out the word “jaundiced”), but even more interesting once I found the source on Firefly’s Index: Awards nominees page. I checked some facts on the UNdata web site, and I’m not sure it’s correct. If it is, that does not mean that 5.7 million would die without treatment; it does not even mean that they would suffer irreparable harm. But here in the developed world, anything more than the most mild case of jaundice is treated with a bili light. Bringing the rest of the world up to that standard would save lives and reduce the number of people suffering the ill effects of jaundice, which include the form of brain damage called Kernicterus. The article continues:
Global health experts estimate 6-10% of all newborn mortality can be attributed to jaundice and complications caused by jaundice.
Is this a world-wide figure? I have often noted that bili lights are ubiquitous in the developed world, so I have to guess that most of those deaths occur in places where they don’t have bili lights. I found an incredible resource, a spreadsheet of neonatal mortality in 1990 and 2009, which makes some further analysis possible. If I’m using the data right, it looks like there were about 3.2 million live births in Africa in 2009 (and after cross-checking with the UNdata, that does appear to be correct). Out of those, the average neonatal mortality rate was 34 to 36, meaning 3.4% to 3.6% of those babies died in their first year of life – more than a million babies. If 6% of those could have been saved by bili lights, that’s sixty thousand babies.
The average bili light treatment for a neonate is 48 to 72 hours, so sixty thousand babies would need (at 48 hours of treatment) at least 120,000 days of treatment. If each bili light were running 24/7/365, then we would only need 329 bili lights to treat all of those babies – in an ideal world. It’s probably more realistic to give them a 50% utility rate (though I’ve heard that some of my bili lights have been used more like 80% of the time.) To get to the point where no baby’s brain is damaged by the lack of availability of a bili light, you will have to have enough capacity to meet the peak demand at each hospital and clinic, so the percentage of time each one is used will be less as they become more ubiquitous.
If we max out the numbers, 10% of neonates get 72 hours treatment each, and 50% utility rate, I get 1,645 bili lights for Africa. Now, as I said above, only a certain percentage of the babies that really should be treated for jaundice will die without treatment – but many more will suffer kernicterus and other complications; complications that may not be life-threatening, but are better avoided, especially when jaundice is so easily treated. So maybe 10% of the neonates need bili lights to survive, but another 20% (this is just a guess) would benefit from them: 30% total, almost 5000 bili lights.
So: low end: 658 bili lights, high end, 5000 bili lights. Let’s call it 3500… Let’s call it 3500 and keep in mind that I’m just guessing at one of the factors.
It’s stunning to think that Africa could be saturated with bili lights if we could only get 3500 of them on the ground there! In terms of production, that’s an achievable goal!
Obviously, a lot of things will have to change before we can reduce jaundice deaths to zero – it’s not just a matter of making a lot of bili lights. Babies with severe jaundice need to be under a physician’s care, and physicians need facilities in which to care for their patients. I can do little to tackle these larger problems, but it’s encouraging to think that the basic goal of producing enough bili lights can be met so easily.
(this is version 2 of this article; the original version suffered from the mistake in the quote from Maker Pro. When I came back to edit, I added the number of lights for the babies that are facing not death, but permanent ill health effects. – tzf)