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## Project Origins

The idea for the IMPALA project originated from the collaboration between pediatric and intensive care specialist Job Calis (Amsterdam UMC), Bart Bierling (industrial designer) and Niek Versteegde (tropical medicine specialist) from the social enterprise GOAL3. Their combined clinical and technical experience has led to the new approach of the IMPALA project.

Principal investigator Job Calis experienced the need firsthand while working on the PICU in Malawi:

> “Timely detection of critical conditions in hospitalized children is essential to save their lives. During my work I have experienced first hand that children died due to the absence or failing of monitoring systems. This is unacceptable.”

To ensure that the system meets local demands and is sustainable, the Dutch medical technology company GOAL 3 will be developing the IMPALA system together with the Polytechnic, the department of biomedical engineering of the Malawi University of Business and Applied Sciences.

### The Challenge

Every year, more than three million children in low-resource settings die due to low quality of care caused by constraints in healthcare systems. Shortage of staff and lack of adequate equipment lead to the needless deaths of millions of children.

In hospitals in low resource settings, subtle but important changes in a child’s health can go unnoticed. As a result, the window of opportunity to intervene and prevent children dying from curable or preventable complications is missed. In high-resource settings monitoring of vital signs like heart rate, blood pressure and respiratory rate is the standard of care to detect these conditions in an early stage. Yet, these monitoring tools are not available in countries like Malawi.

Existing monitoring systems are designed for high-income settings and cost a few thousand euros with disposable sensors that require constant repurchasing. These prices exceed the financial capacity of low-resource hospitals. In addition, these systems are complex to use and interpret and the skills and knowledge needed to operate and maintain these systems are scarce. Therefore, these systems break down, or are not used adequately and thus they prove ineffective in low resource settings.

### The Solution

The aim of this interdisciplinary project is to develop an algorithm enhanced monitor for low-resource environments that enables health workers to timely detect critical conditions and perform life saving interventions. The design focuses on a durable and easy to use system that makes it easier to collect vital signs like oxygen saturation, heart rate and breathing rate. One of the innovations is the use of a very sensitive pressure sensor that is put underneath the mattress for measurement of the vital signs. The signals from this and other sensors are processed by algorithms to detect changes in vital signs that may indicate serious illness hours before even highly trained healthcare workers would be able to identify the issue.

Another exciting development within this study are the lab-on-a-chip biomarkers which are being developed by the Imperial College London. These accurate point of care tests that require only a drop of blood are able to differentiate between Malaria, bacterial and viral infection in a matter of minutes. Combining the IMPALA monitoring system and the lab-on-a-chip biomarkers could revolutionize the diagnosing process in these resource constraint settings.