Cheap Paper Microscope to Boost Fight Against Diseases

To tackle diseases in the developing world, the most important first step is diagnosis. Without effective diagnosis, it is difficult to go to the next steps of either treatment or cure. While much attention is given to the high costs involved in treating and curing ailments, screening for diagnosis is also expensive, especially if it involves lots of people. Anything that can reduce the cost of diagnosis will free up resources to expand the number of people who can be checked, and help eradicate contagious diseases.

One innovation is an inexpensive microscope that could allow diagnosing diseases such as malaria to be done on a much larger scale. Called the Foldscope (foldscope.com), it is made from paper, comes in a variety of bright colors and resembles the cardboard, three-dimensional cut-and-keep models regularly found in children’s books and magazines.

Foldscope’s designs are developed on a computer and then printed. Foldscopes are made from thick paper, glue, a switch, a battery and a light-emitting diode (LED) (http://en.wikipedia.org/wiki/Light-emitting_diode).

Inspired by the ancient Japanese paper-folding craft of Origami (http://en.wikipedia.org/wiki/Origami), Foldscope’s makers at the Prakash Lab at Stanford University (http://www.stanford.edu/~manup/) are trying to create “scientific tools that can scale up to match problems in global health and science education”, according to their website.

The Foldscope can be put together in less than 10 minutes (http://www.youtube.com/watch?v=rphTSmb-Ux4) using a pair of scissors, packing tape and tweezers.

Once assembled, a user places a standard glass microscope slide in the Foldscope, turns on the LED light and uses their thumbs to guide the lens to view the slide.

Each Foldscope can magnify up to 2000 times with a sub-micron resolution of 800 nm. The battery can last up to 50 hours on a single button-cell battery and requires no further external power. Its makers claim it can survive being stepped on or dropped from a three-storey building.
It can perform a wide variety of microscopy techniques.

Its makers hope to manufacture billions of Foldscopes a year by exploiting the cheapness of the material and the simplicity of construction.

A beta test called “Ten Thousand Microscopes” will enlist 10,000 people to test the Foldscope in the field. Participants will contribute to helping write a field manual for the Foldscope prior to mass manufacturing. The Foldscope costs just US $0.50 to make for the basic model and US $1 for a higher-magnification version.

Field tests are taking place in the United States, Uganda and India.

Foldscope is designed to be used where more sophisticated lab analysis is not possible or affordable. It can also be an educational tool to give students experience in hands-on microscopy, or build awareness in the general population of how infectious diseases are spread by unseen lifeforms.

Foldscope’s makers hope their creation will help diagnose common but devastating diseases including Plasmodium falciparum (malaria), Trypanosome cruzi (Chagas disease), Giradia lamblia (giardiasis), Leishmania donovani (leishmaniasis), Dirofilaria immitis (filariasis), Human Sickle Cell (sickle-cell anaemia), E. Coli and Bacillus and Pine strobilus.

The quantity of people that need to be checked for diseases is vast and means, in countries where incomes and resources are low, it just isn’t possible to undertake diagnostic services using conventional methods.

“There is definitely a huge gap between where we are and where we want to be,” Stanford School of Medicine Assistant Professor for Bioengineering Manu Prakash explained on the university’s website.

“When you do get it (malaria), there is this simple-minded thing ‘forget diagnostics, let’s just get that tablet’ – and that’s what happens in most of the world. But the problem is there is many different strains, there are many different medications, you could potentially make the problem even worse by not realizing that you have malaria. And at the same time, the people who get a severe case – they are not detected at all.

“What is that one thing that you could almost distribute for free that starts to match the specificity of what detection requires? For malaria, the standard is to be able to image, and sit on a microscope and essentially go through slides.

“What we found as a challenge, if you truly want to scale, you should be really testing more than a billion people every year: that’s a billion tests a year. Any platform that you can imagine needs to scale to those numbers to make an impact.

“One of these things that have been shown over and over again – if you can put (in place) an infrastructure to fight malaria that is scalable and sustainable, then you get retraction of malaria in different regions.”

By David South, Development Challenges, South-South Solutions

Published: April 2014

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

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Small-scale Farmers Can Fight Malaria Battle

Malaria is one of Africa’s biggest killers. Each year globally 300 to 500 million people are infected, and around 1 million die from the disease (theglobalfund). Ninety percent of malaria deaths occur in sub-Saharan Africa – mostly to children under the age of five. The disease costs African countries US$12 billion a year in lost gross domestic product.

Malaria is a parasitic disease – the parasite plasmodium – transmitted by mosquito bites. Symptoms include fever, headache and vomiting. Internal bleeding, kidney and liver failure may follow and can result in coma and death.

The most common and effective treatment, recommended by the World Health Organization, is artemisinin-based combination therapies, known as ACTs. ACTs have low toxicity, few side effects and act rapidly against the parasite. Research shows that artemisinin remedies cure 90 percent of patients within three days.

But there are far fewer doses available than people who need them. WHO has claimed the quantity made available by pharmaceutical companies falls far short of the more than 130 million doses required to combat malaria throughout the world.

And ACTs are very expensive to deliver: in just one country, Tanzania, providing such therapy for three years would cost US $48.3 million. Every year, this would account for 9.5 percent of Tanzania’s health budget, and 28.7 percent of yearly spending on medical supplies: a six-fold increase in budget for malaria treatment (Malaria Journal 2008, 7:4).

But a cheap alternative to the expensive pill form of the treatment is being piloted across Africa. It involves the drinking of a tea made from the bushes of the artemisia plant. Artemisia annua is an annual shrub and the active ingredient in the pills (artemisinin). It is native to China and Vietnam and has been used for 2,000 years to treat fevers.

Bushes cultivated by farmers in Kenya, Malawi, Tanzania, Zambia, Zimbabwe and Mozambique under the supervision of the World Agroforestry Centre in Nairobi, Kenya, are helping to bring down malaria rates without the long wait for the pills to arrive.

The leaves are boiled and made into a tea. Drinking the tea gives a high enough dose of artemisinin in the blood to cure malaria. Helen Meyer, a nurse operating nine mobile health clinics in rural Mozambique, is using the bitter tea made from the dried leaves. Even in treating drug resistant malaria, she has found the artemisia tea effective: “If you drink the tea, you feel better after the first day. Other medicines take a few days.”

A special hybrid of artemisia, A-3, is used because it is adapted for warmer climates. The wild variety grows to only five centimetres in the tropics, but A-3 grows to three metres and packs 20 times more artemisinin. It is also highly economical: thousands of plants can come from a single stem.

The daily adult dose of anti-malaria tea just needs five grams of dried A-3 leaves in one litre of water. The tea is drunk every six hours for seven days. Each plant produces 200 grams of dried leaves, and a thousand shrubs can cure 5,700 people. Since it is a cheap cure, money can be spent instead on other things. Farmers are also able to supplement their income by growing the bushes. And the dried leaves have long-lasting power: even after three years the leaves retain close to a 100 percent of their artemisinin.

Access to authentic artemisinin is critical: it is estimated 16 percent of malaria medicines in Kenya are counterfeit. Elsewhere, the proliferation of counterfeit anti-malarials substantially raises the risk of the emergence of resistance to artemesinin combination therapy, the last truly effective treatment against malaria. Past misuse of other malaria drugs, such as chloroquine in the 1980s and sulphadoxine/pyrimethamine in the 1990s, resulted in the malaria parasite becoming resistant. Hundreds of thousands of people in malaria-prone areas may have died as a result.

The World Agroforestry Centre, recognizing potential problems with artemesinin monotherapies, is working to combine it with indigenous herbal remedies made from other anti-malarial trees, producing a herbal combination therapy (HCT).

“I used to grow fruits and beans here,” said Charles Kiruthi, a Kenyan farmer, to the IRIN news service. “but I will get a better return from this plant. No pests attack it, and until harvesting time it requires very little labour.”

“I expect to get a good return, and I am also very happy to be helping fight malaria,” continued Kiruthi. “I recently lost two friends to the disease, and my child gets sick with malaria sometimes.”

By David South, Development Challenges, South-South Solutions

Published: July 2008

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

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Combating Counterfeit Drugs

Access to good quality drugs is a serious problem across the South. The International Narcotics Control Board estimates that up to 15 per cent of all drugs sold around the world are fake or counterfeit, and in parts of Africa and Asia this figure jumps to 50 per cent. The US Food and Drug Administration estimates counterfeit drugs make up 10 per cent of the global medicine market. The US Centre for Medicines in the Public Interest predicts counterfeit drug sales will reach US $75 billion globally in 2010, an increase of more than 90 per cent from 2005.

Fake drugs are a major cause of unnecessary death and destroy public confidence in medicines and health services. While counterfeit drugs have been on the rise, there is little co-ordinated or effective action to counter this menace afflicted on the sick.

But in Ghana, a solution has emerged that shows a way to guarantee that quality drugs get to the sick who need them. CareShop Ghana uses the franchise model – where licenses are sold to approved vendors who adhere to strict guidelines – to ensure that the quality, accessibility and affordability of essential medicines in and around Accra is guaranteed. CareShop has made deals with close to 300 franchisee pharmacies – often modest operations – who sell over-the-counter drugs.

In Ghana, preventable and curable illnesses like malaria and diarrhoeal diseases are among the leading causes of death. Their treatment pushes many people to financial despair; they can ill afford the extra burden of worrying about counterfeit drugs and the harm they do. Like many countries in the South, Ghana’s public healthcare system is unable to meet these needs and so most people turn to the private sector for help.

An estimated 65 per cent of people turn to licensed pharmacies. But many of these operate haphazard businesses, dispensing expired or counterfeit drugs.

The Ghana Social Marketing Foundation Enterprises Limited (GSMFEL) founded CareShop in 2002, hoping to battle common infectious diseases in poor areas by making sure good drugs get through to the sick.

GSMFEL makes a small profit as the franchisor by selling high-quality drugs to the franchisees. The key to CareShop’s success is imposing standardization on franchisees, so they have to stick to common diagnosis, quality and pricing. They make more money when they adhere to these rules than when they break them. To ensure there is no tampering with the drugs, they are delivered straight to the vendor’s doorsteps, and it is all backed up with health and business training support and branded materials.

The tide can be turned around on fake drugs: in 2002, the WHO reported that 70 per cent of drugs in Nigeria were fake or substandard: by 2004 that figure had fallen to 48 per cent.

Stimulating private sector solutions to African healthcare problems is now receiving an additional boost from a new fund established by the World Bank’s private sector arm, the International Finance Corporation. Launched in 2007, it offers cash and loans totalling US $500 million to commercial healthcare projects in Africa. According to its own statistics, 60 per cent of health expenditure in sub-Saharan Africa is privately funded, and the market, excluding South Africa, is worth US $19 billion.

By David South, Development Challenges, South-South Solutions

Published: May 2008

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

Follow @SouthSouth1

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