Sidi Deng, PhD Student
1. Optimizing the economic performance of CMI Technologies
The Critical Materials Institute (CMI) focuses on technologies that make better use of materials and eliminate the need for materials that are subject to supply disruptions. These critical materials are essential for American competitiveness in clean energy. Many materials considered critical by the U.S. Department of Energy are used in modern clean energy technologies, including wind turbines, solar panels, electric vehicles, and energy-efficient lighting.
This project is part of CMI Focus Area 4: crosscutting research, which collaborates with other focus areas to provide supportive work.
To this point, the efforts at Purdue (Dr. John W. Sutherland et al.) related to techno-economic analysis (TEA) have largely focused on two activities: (a) working with CMI scientists/engineers to conduct TEAs on their technologies/processes once they have reached TRL 4, and b) developing user friendly software that allows CMI researchers (and others) to perform their own TEAs at whatever TRL stage they wish.
Our experiences to date within CMI helped shape our proposed activities for years 6-10 of CMI. This plan calls for continuing to work with researchers on TEA applications at the earliest TRL stage possible, improvement of the usability of the TEA software, and the effective use of statistical experimental design techniques in CMI efforts to optimize experimental effort.
In order to predict essential parameters for TEA at an early TRL stage, machine learning methods and agent-based modeling are being studied. It is envisioned that these prediction models can be applied in general CMI projects, and will be incorporated into the newly-developed CMI software.
Collaborators and Funding Sources
The project is funded by the Critical Materials Institute (CMI). I am under the supervision of Dr. John W. Sutherland at the School of Environmental and Ecological Engineering, collaborating with graduate students Jesus Perez-Cardona and Akash Patil.
2. Integrating Family-Centered Kangaroo Mother Care into Health Systems
Background: Kangaroo Mother Care (KMC), consisting of prolonged skin-to-skin contact and exclusive breastfeeding, is an evidence-based, life-saving intervention for preterm infants that requires family-centered care. In district hospitals in Malawi, KMC is often delivered in a KMC unit. Smaller, sicker babies in the newborn unit must sometimes forgo KMC or skin-to-skin (STS) contact due to space constraints, despite the fact that these babies have the greatest potential survival gains from practicing KMC/STS. Further, many existing KMC units often lack sufficient space to comfortably accommodate all eligible mother-baby dyads and relevant family members. Working with Ntcheu District Hospital, Save the Children-Malawi, Save the Children-US, and Purdue University’s Innovation for International Development Lab (I2D) will create a space-saving innovation (SSI) consisting of 1.) floorplan and 2.) space-saving furniture (KMC chair, infant crib, and mobile nursing station) that integrate KMC/STS into the newborn unit and increase the comfort and capacity of current KMC units, thus enabling more babies to receive this life-saving intervention.
Objective: The aim of this study is to evaluate how the SSI impacts the duration of KMC/STS in the newborn unit and the involvement of family in the newborn unit and KMC unit.
Methodology: This study will take place at Ntcheu District Hospital, where the SSI will be implemented. The study will be a mixed methods design, consisting of a quantitative component (cross-sectional design) and structured qualitative component (two in-depth interviews: one for families, one for healthcare providers). For the quantitative component, nurses will track time spent in KMC/STS before and after implementation of the SSI in the newborn unit for mother-baby dyads meeting eligibility criteria and providing informed consent. Time in KMC/STS will be tracked using a simple add-on form to the patient bedside record. For the structured qualitative component, once the SSI is implemented, families meeting eligibility criteria and providing informed consent will be interviewed regarding their satisfaction with family-centered care and general design of the newborn and KMC units. Healthcare providers meeting eligibility criteria and providing informed consent will be interviewed regarding satisfaction with layout and furniture in newborn unit and KMC unit.
Findings and conclusions: Research results, along with blueprints and design plans for the SSI will be made available to Ntcheu district hospital and relevant national committees in Malawi. All blueprints and design plans will be open-source and available for reproduction in Malawi and other countries worldwide. All space-saving furniture pieces built for the study will be given to Ntcheu district hospital as gift to keep at the end of the study, and the data from the study are expected to improve standard of care for mothers and babies at Ntcheu district hospital through increased STS/KMC duration and improved family involvement. We will publish the blueprints and relevant study findings in peer-review journals and online, so that other facilities, whether in Malawi or other parts of the world, may use the blueprints to create and built locally-adapted layouts and space-saving furniture, and use the study results to inform their own implementation of the SSI.
Kangaroo mother care (KMC) is an evidence-based approach to reducing mortality and morbidity in low birth weight (LBW) and preterm infants, recommended by the WHO as a priority intervention to address preterm morbidity and mortality (2). Kangaroo Mother Care consists of continuous skin-to-skin contact between mother and baby and exclusive breastfeeding. While there is professional consensus that continuous KMC is optimal, intermittent KMC for shorter duration has also show to have significant benefit for preterm infants. KMC centers heavily on the mother and family, rather than the health provider and technology, and thus traditional health systems are not well-equipped to ensure success. Indeed, global coverage of KMC is estimated to be less than 5% for preterm babies. This low coverage is due, in part, to the fact that health facilities are not currently equipped to deliver the family-centered care preterm infants need, namely KMC.
KMC has been systematically scaled up across Malawi since its first introduction at Zomba Central Hospital in 1999. As of August 2011, KMC was available in 121 facilities, including all central and most of the hospitals in the country. In the Road Map for accelerating the reduction of Maternal and Neonatal Morbidity and Mortality in Malawi, published by the Ministry of Health in October 2012, KMC was listed as part of a minimum package for essential neonatal care. KMC was also listed as a priority intervention in Malawi’s Every Newborn Action Plan (ENAP), which was launched in July 2015 (5).
Nonetheless, research suggests that Malawi still has challenges with regards to KMC implementation. An in-depth evaluation of 14 healthcare facilities that offered KMC across Malawi in February 2012 found that only half of the facilities were observed to have "diligent compliance in doing KMC." A comprehensive EmONC assessment in 2014 that covered all hospitals across Malawi found similar results. While 77% of hospitals reported that they provided inpatient KMC services, just 75% of these had the most basic elements for (staff, space for KMC and functional scale) (7).
A multi-country health systems bottleneck analysis for KMC conducted in 2015 described the following as leading challenges to effective implementation of KMC in low resource settings: lack of space/supplies, shortage of appropriately competent health workers, and lack of mobilization in the community to support mothers providing KMC (Vesel et al., 2015). Developing innovative solutions to tackle these implementation challenges is critical to the eventual success of scaling up KMC. The SSI will address one of the leading barriers to effective KMC practice in Malawi and beyond: lack of space.
i Preterm birth is defined as birth occurring before 37 weeks gestation
Malawi has been a leader in KMC implementation and research, and has shared their progress in several international forums. Thus far, no implementation projects or research in Malawi, Africa, or beyond, have focused on innovating and re-thinking the physical space in which KMC takes place, despite the fact that this is a leading barrier to effective KMC practice in Malawi and worldwide.
Save the Children has extensive experience implementing and studying KMC in Malawi, and improving quality of care for small babies at the district level. Purdue University’s Innovation for International Development Lab (I2D) has extensive international experience in workflow design, complex system design, healthcare delivery improvement, process design, furniture design and production and distribution systems. Together, these agencies are well-positioned to work with management and staff at Ntcheu district hospital to develop and test innovative approaches to addressing the physical space challenge for implementing KMC and STS.
As far as we know, no other groups have designed or studied interventions for addressing the physical space challenge to KMC implementation. This study fills a gap in local and international KMC research regarding the physical space barrier for KMC and positions Malawi to be a global leader in physical space design for KMC.
This study will test the hypothesis that an improved layout and use of space-saving furniture in the newborn unit will significantly improve the duration of KMC/STS. Additional structured qualitative investigations will describe family involvement in care for the newborn and family and health care provider satisfaction of the SSI in both the newborn unit and KMC unit.
Objectives of the study
The overall objectives of the SSI project are:
More babies in the newborn unit (i.e. the smallest and sickest) receive KMC/STS
Care spaces (newborn unit and KMC unit) are more family-centered
Primary Study Aim: The aim of this study is to evaluate how the SSI impacts the duration of KMC/STS in the newborn unit and the involvement of family in the newborn unit and KMC unit.
Measure duration of skin-to-skin contact in the newborn unit before and after implementation of the SSI.
Assess involvement of mother and family members in the care for newborns in the newborn unit and KMC unit
Assess maternal satisfaction with the care, layout, and furniture in the newborn unit and KMC unit
Assess health provider satisfaction with the new layout and furniture in the newborn unit and KMC unit, solicit practical feedback for improving the design, and gather perceptions of improvements to family-centered care.
The primary outcome variable will be to compare the average number of hours spent in KMC/STS among eligible babies in the newborn unit before and after the intervention.
We will also evaluate the involvement of family in each care space using the illustrative quantitative and qualitative indicators. Illustrative indicators are listed and outlined by objective below. (Please see attached data collection tools):
Assess involvement of mother and family members in the care for newborns in the newborn unit and KMC unit:
Number of family members (other than mother) that has spent any time helping care for the newborn,
Number of family members (other than the mother) that has visited the KMC unit and held the baby in STS position.
Number of family members (other than the mother) that has been involved in counseling provided by health providers
Assess maternal satisfaction with the space-saving furniture in the newborn unit and KMC unit and solicit practical feedback for improving the design:
Satisfaction scores for multiple functional aspects of the KMC chair and when, applicable, infant crib, as well as and suggestions for improvement for both pieces of furniture.
Assess health provider satisfaction with the new layout and furniture in the newborn unit and KMC unit and solicit practical feedback for improving the design.
Satisfaction scores for the space-saving furniture (mobile nursing station, KMC chair, infant crib) and suggestions for improvement
Perception scores of impact of the SSI on improving family-centered care, and suggestions for improvement