FAQ

When did this project started, with what aim?

The Frugal Thermometer project is an initiative supported by the Centre for Frugal Innovation in Africa and it is carried out by the Leiden University Medical Centre and the Faculty of Industrial Design Engineering at Delft University of Technology since 2012.

What is fever and why are fever diagnostics so important?

The prevailing subjective nature of fever, makes it still today, a widely discussed topic amongst the medical community. Fever, medically known as pyrexia, is a subjective measurement of the upward deviation from a person’s normal body temperature. As such, its interpretation and meaning are guided by different explanatory models that vary across cultural communities and in the world. It should be noted that fever is not inherently bad. It is a symptom that can be caused by an infection, but can also be caused by non-infectious illnesses such as stroke, blood clots, gout attacks, vaccination or simple overdressing. The majority of fevers are associated with common viral diseases that the body is capable of clearing without further medical assistance.

In some cases, namely in low-resource settings, the inability to interpret fever, a lack of information and supportive health system, often leads to over – or – under diagnostics. Besides having a direct impact in the health condition and trust of someone seeking health, poor diagnostics represent an expenditure burden for health services.

Why measure fever on the forehead, isn’t that less accurate?

There are many factors that can influence the body temperature. The age, genre and ethnicity of a person, the time of day, ambient environmental settings and physical exercise can all influence the body temperature. Furthermore, if a person’s temperature is to be taken orally, consuming a hot beverage or meal beforehand may increase the thermometer’s reading.

The sites of measurement also show that body temperature is not constant throughout the body. The rectal temperature is generally regarded as the warmest (and most accurate) site for measurement, whereas the axillary (in the armpit) temperature is notably lower than the other measuring sites. All these different sites and measurement techniques bring up varying degrees of comfort, hygiene and cultural acceptance.

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Graphic 1. Normal body temperature ranges (source: WelchAllyn)

The accuracy question is an important one, but it should also be regarded as a trade-off. Depending on who is to read the temperature and how far the follow-up of the treatment can be done. On the other hand, high fevers (>40 degrees Celsius) are often easily detectable by additional symptoms whereas a febrile condition, where body temperature varies in time to shape a pattern, are not easy to distinguish without accurate monitoring. For a medical doctor or nurse in healthcare settings, accuracy, as well as frequency of measurements are important. But for a caregiver in a household that may be different depending on literacy level and cultural beliefs. In the latter case, a clear indication of the degree of illness may be more important than an objective number.

Why a new thermometer?

The fever thermometer is an essential health technology and the entry point to a diversity of diagnostics in most healthcare systems. The lack of accessibility to an accurate and reliable diagnostic of fever, the misinterpretation of fever symptoms and its association with diseases such as Malaria, have direct implications on the costs of healthcare and on the health of patients seeking care. These are either misdiagnosed, over prescribed with medication, or lost from the health system because of a mismatch with expectations. Current thermometer designs are still not universally available and their designs are unsuitable to be purchased and used in remote and rural regions of the globe. In addition, they lack the ability to objectify fever and translate it into clear thresholds that support decision making by users.

Throughout the different design iterations, the design teams faced several trade-offs including compatibility with unique local circumstances of diverse contexts, safety, maintenance, performance and price, energy source, physical reliability, medical evidence and accuracy of measurements, display intuitiveness, local and international models of production and distribution. We learned that the thermometer, unlike the stethoscope, does not provide a sense of status to medical doctors; that in health consultations fever measurement with traditional arm-pit thermometers is, besides unhygienic, an unpleasant experience for both caregiver and caretaker. We also learned that there are many different types of users of a thermometer: from a medical doctor to an adolescent mother or an NGO worker. And that for all of them, there are different requirements that make fever assessment effective. So we took up the challenge to redesign and reinvent fever diagnostics based on all we know. And that turned out to be a process where we are constantly asking more questions than answering them!

Why two different thermometers?

The first thermometer “stamp” was designed by Asli team, a group of industrial design master students that traveled for four weeks to Masindi, in Uganda to engage with the local community and personnel from health services. They organized several information and co-design sessions, build prototypes together with the community and finally made decisions about the final features of the thermometer. The second thermometer was designed by the AED team, a group of industrial design master students that used design thinking principles to explore variations of the thermometer, based on the previous group. Their aim was to design an affordable, local producible and aesthetically pleasing product.

The fact that we now have two thermometer designs has helped us to engage in very rich conversations about advantages and disadvantages of each. Through that dialogue we gained new insights about the diversity of different ecosystems around a thermometer. Through design thinking, we will keep using thermometer design iterations to facilitate the learning experience about fever diagnostics.

Frugal innovations may play an important role in bridging the wide gap between what is available and what is needed in the health sector in low resource settings. The challenge is not just simply providing stripped-down versions of western medical products, but instead providing value-sensitive innovations that are truly compatible with the unique local circumstances of this specific context.

In this project we define frugal as a multidisciplinary approach where the crossing of medicine and design engineering has the potential to offer new perspectives to health technologies. We focus on achieving the most quality and accessibility, with the least cost and barriers of use, developing value-sensitive innovations that include consideration for human factors involved in the development, procurement, use and disposal of technologies (e.g. individual, relational and organizational aspects), the technical eco-system and the underlying financing model needed to sustain such innovations.

What is the price of the thermometer?

We are frequently asked about the price of the thermometers we designed. Although the cost of production of these prototypes is clear to us, the price of the thermometer itself is dependent on the specific ecosystem you focus on and on a number of other factors. So we prefer to talk about price as a trade-off. First, price depends on who is using it, buying and selling it. For example, if the thermometer is distributed for free by national governments you need a totally different cost structure than if it is supplied at cost to for-profit pharmacies. Second, it depends on how the thermometer is used. For example, the thermometer can be sold as a standalone product in pharmacies or it can be used as a service. In these two models the price of the thermometer is also different. Finally, if we consider the value the savings for the health sector of not over prescribing drugs, the gain of health seekers with trust in health services and if we consider the, the potential impact of a thermometer compensates for a higher price.

What means Frugal?

Frugal innovations may play an important role in bridging the wide gap between what is available and what is needed in the health sector in low resource settings. The challenge is not just simply providing stripped-down versions of western medical products, but instead providing value-sensitive innovations that are truly compatible with the unique local circumstances of this specific context.

In this project we define frugal as a multidisciplinary approach where the crossing of medicine and design engineering has the potential to offer new perspectives to health technologies. We focus on achieving the most quality and accessibility, with the least cost and barriers of use, developing value-sensitive innovations that include consideration for human factors involved in the development, procurement, use and disposal of technologies (e.g. individual, relational and organizational aspects), the technical eco-system and the underlying financing model needed to sustain such innovations.

What challenges are you addressing now?

Besides actively looking for partners and funding, we work hard to learn and publish about a range of challenges related to the concept of a frugal thermometer. For example, what are the minimum and maximum quality standards for the frugal thermometer and its ecosystem, in order to increase its accessibility and performance? How can the frugal thermometer contribute to the proper identification and distinction of different fever-related illnesses?

How can I contribute?

We are prone to expand our team. We are looking specifically for people with knowledge and experience in diagnostics, in patterns of febrile illnesses, in medical product-service system design, and generally for enthusiasts of sustainability, global health and sharing.