DESIGN CHALLENGE: INFANT HEIGHT MEASURING BOARD
Undernutrition is a significant global problem, contributing to nearly half of all deaths of children under 5. In Nepal, efforts are focused around identifying and treating cases of acute malnourishment (wasting) in under 5's, which affects around 14% of the population. To identify cases of malnourishment, organisations such as UNICEF (a world leading organisation in combating undernutrition) rely on a series of measures, including height, arm circumference, and weight. It is vital that the tools they use are accurate and intuitive for the health workers that use them, but various studies have shed doubt on the reliability of these tools.
Further examination reveals that despite the equipment being robust and accurate, there are numerous usability issues which can cause inaccuracies and errors in taking, reading and interpreting the measurements.
The board costs $160. It is imported by sea from a warehouse in Copenhagen, which adds a 15% transport cost. Transport in country is also estimated at around 15-120% of the purchase cost (higher costs are for very remote areas in the mountains, only accessible by foot).
In country transport: $24-$192
2) LEAD TIME
From the point of order, the order takes a week to be approved by various parties. The boards are shipped from Copenhagen, which takes anything from 1.5-3 months. They must pass customs, which on a good day takes about a week, but presently under blockade customs can take up to a month. Once passed, the boards are taken to the UNICEF country warehouse, before being moved to the government country warehouse. From this point logistics is out of the hands of the NGO, and in the hands of the government, who must move the boards to the correct district warehouse, then often the correct sub-district warehouse before finally reaching the health posts. The complexities of moving materials in highly mountainous terrain with poor roads means that this process can take anything from a couple of weeks to several months.
The boards weight around 5.7kg, and depending on the exact model, they may have a metal or plastic handle positioned on the side, or straps to turn it into a backpack. Imagine carrying this for several days whilst conducting field surveys on foot with lots of other equipment - the realities are that this is a heavy, bulky object. What's more, the process of assembling and disassembling the board is time consuming, and the part which holds the two halves together in collapsed form is easily lost.
To be able to use the board and get repeatable results requires a significant input of training time. There are certain nuances, such as knowing to measure children under 2 years of age in a lying down position, and no matter what the age to ensure the child has their head level and shoulders, buttocks and backs of the knees touching the board. The measurements need to be taken with eye level straight on, and it can be confusing to see exactly where to take the measurement (it can be non-obvious whether to take the reading above or below the slider). The measurement must then be cross referenced with age on a graph to identify if the child is malnourished, which can be non-intuitive for individuals who are unfamiliar with reading graphs and charts.
5) CHILD FRIENDLINESS
Children find the experience traumatic, which can lead to errors in taking measurements. For example, when a baby is upset, it has a tendency to point its toes and push the slider away - for a correct measurement, the heels must be flat. However, taking measurements from a struggling, screaming baby, whilst trying to hold the baby in the correct position and operate the slider, often results in a 'near enough' attitude.