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Introduction

Healthcare is the maintenance of health, the adequate measures taken to prevent and manage any sickness, injuries and ailments According to standardized reports, a proper health care system needs proper financing; a workforce that is adequately trained and paid; a steady source of information which can be relied on; and proper healthcare facility with appropriate facilities and delivery systems (Boon et al., 2004). Healthcare facilities can be government managed, or privately managed, but all of them have to adhere to the principles of the healthcare delivery system. As the fastest growing industry, healthcare has advanced in leaps and bounds, constantly evolving to cater to the changing needs and expectations from the recipients of healthcare. A major revolution in healthcare came when technology was introduced in it. This created a great change, as many procedures could be easily performed, and many lives could be saved.

The World Health Organization defines Health technology as the “application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives” (The World Health Organization, 2016). The organized knowledge and skills might be pharmaceutical support, various devices and equipment used in medical care, the application of advanced technology like robotic engineering in healthcare, etc. The main purpose of using advanced technology in healthcare is to ensure quality healthcare to all. The conventional methods of healthcare were sure suited to the olden times, but with the high rise in population, disease and death rate, and with the need to focus more on preventive health than to focus on treatment, it is essential to include the advancing technology as a part and parcel of healthcare.

It is important to ensure that the technology utilized is not overwhelming, but cost effective and practical in its use. One such implementation of technology is Wearable Medical Devices, or WMD’s (Rao, 2015). This project is proposed to test the efficacy of wearable medical devices in the healthcare of infants, thereby ensuring good health by preventing illness.

Significance and Innovation of the Proposed Study

Healthcare in infants is a highly sensitive issue, which can turn from good to worse in a matter of minutes. One of the most important aspects of newborn health is its hydration, and its ability to thrive. It is essential to constantly monitor the child for proper urination, which is the key to proper hydration. Urinary tract infections due to improper hydration is very common in infants, and can get very serious, but can be managed if detected early (Beetz, 2003). One of the main indicators of urinary tract infections is a change in the properties of urine such as color, odour, and quantity. As many children are put on a diaper during that phase of life, the most practicable solution would be the use of a diaper which detects any differences in urine which passes out of the child’s body, and gives an alert at the monitoring site, so that immediate action is taken.

The significance of this project is that the use of a wearable medical device as simple as a diaper is highly essential to monitor a child’s health. It is innovative, as it is the application of advancement of technology in a practical method.

Aims of the Study

This study aims at analyzing the hydration status of infants using the wearable medical device – “Smart Diapers” (Sidén et al., 2004), which would be effective in the early detection and prevention of urinary tract related illness. It also aims to provide health education to the public on the easy application of technology in keeping good health.

Background and Review of Literature

Given the purpose and aim of the study, relevant literature supporting the need of advanced technology in the field of healthcare, the use of wearable technology in healthcare, the significance of monitoring pediatric health, the effects and use of smart diapers in the early monitoring of pediatric hydration etc. were reviewed. Only peer reviewed full-text scientific journals, books, and scientific reports that were published after 2006 were considered for the study. In this proposal, excerpts and annotations from ten scientific articles are reviewed.

In his book on medical technology, Faulkner (2008) talks about how the use of medical technology has an impact on the society. The author has covered the inception of technology in healthcare, its history of usage, the growing demand for quality healthcare and the constant steps taken to manage them, and the emergence of evidence based medicine and its impact on healthcare technology. Different aspects of healthcare technology such as its psychological, sociological, physiological, actual working, its need, and the various innovations that have crossed its path have been focused on. The book also provides a comprehensive cover of the various technological devices used in healthcare so far, from bandages to biofeedback devices, and also throws light on probable futuristic advancements.

A study by Kumar (2011) focuses on the costs healthcare technology incurs to the healthcare delivery system and its stakeholders. In his report, the author focuses on the increased cost of outdated technology, and the immediate need to update oneself and the medical practice with the latest technology. It is also discussed that the latest technological devices that are being designed bust bear in mind the cost effectiveness, and its ease of accessibility to the common man. The author encourages innovations that work at a nominal cost, thus providing a high range of efficacy and thereby serving its purpose.

Varshney (2007), in their paper has discussed on “Pervasive healthcare” or healthcare to all, which is the ideal goal of healthcare technology. The author has spoken on the increasing use of wireless technology in day to day life, and the idea to implement it in healthcare has increased the ways to benefit from it. It also discusses on creating a better solution to the problems of today, and better questions for future research. The proposed healthcare by pervasive technology includes pervasive monitoring of health, an emergency management program, easy and effective access to healthcare data, and a universal advanced telemedicine service.

A study by Gatzoulis & Iakovidis (2007) discusses on the efficacy of wearable and portable eHealth systems in today’s life. The authors put forward their views that the use of wearable medical devices would help the healthcare delivery system in may ways, such as  minimizing the time and costs incurred in the treatment of any condition, and saving medical resources in the process. According to the authors, the emergence of wearable medical technology and their implementation in day to day life is a paradigm shift in the face of healthcare, and can help bring about a vast change for the better.

A study by Gibson‐Moore (2013) focuses on the necessity of proper hydration in children.In this study, the author focuses on the importance of drinking adequate amounts of water, the immediate recognition of any changes in the properties of urine, the inculcation of healthy diet habits in children. The recommendations f the adequate amount of fluid intake in children by the European Food Safety Authority (EFSA) is also mentioned, with a mention of a guide of healthy nutrition by the British Nutrition foundation. Additionally, the author focuses on improper hydration, and the ways to prevent it and detect it early.

Whiting et al (2006), in their systematic review have spoken on the clinical manifestations of the urinary tract infections in children, and how harmful it can be if not managed properly. The potential complications of a missed diagnosis or a mis-diagnosis of pediatric illnesses are also discussed. Diagnostic accuracies for the testing of UTI’s were discussed, and clinical observation along with urine sampling are found to be the best methods to detect UTI’s. The authors have recommended early detection, proper diagnosis and treatment, and preventive strategies, in order to manage urinary tract infections in children, especially infants.

In his paper, Leicester (2007) has focused on the diagnosis and management of urinary tract infections in children, which is an adaptation from the guidelines given by the National Institute for Health and Clinical Excellence. The author provides statistical data on the number of children who are affected by urinary tract infections on an average, the basic symptoms which are a high risk for urinary tract infections, the ways to detect urinary infections, and the main findings one can get if presented with a case of urinary tract infections.

A report by Yambem et al (2008) discusses of a new wireless sensor mechanism for the application of smart diapers. It consists of an interrogator circuit, an antenna, and a sensor. The authors also discuss the mechanism in which the smart diaper works, i.e. through the principle of induction coupling, which establishes a wireless link between the sensor and interrogator circuit. When the child wets the diaper, the sensor senses the wetness, and the information is passed to the circuit by the antenna, by proper tuning of frequencies. The authors discuss on how effective the circuit can be made, by modifying the strength of the sensor, and making the pricing optimal for common usage.

In a report by Fish & Traynor (2013), the authors talk about the uses of sensor technology in the management of urinary incontinence. The introduction of smart diapers in the management of urinary incontinence can alert the person about their involuntary leak, and can help see a pattern in the incontinence, whether it is improving or not. The sensor in the smart diaper would send a signal to the receiver, which an be visible in the person’s handheld device, which can record the number of accidents which have occurred due to incontinence. Thus, the authors conclude that the utilization of technological innovations for managing healthcare issues is a great step in healthcare advancement.

The literature studied give a comprehensive idea on the use of technology in healthcare. Findings specific to the aim of the study, which is to analyses the hydration status of infants using wearable technology, thus attempting to detect earl urinary tract disturbances are also obtained. With the necessary evidences, the study is proceeded with.

Research Plan and Methodology

The basic idea of this study is to check for the day to day hydration status in children, by using a wearable medical technological device “Smart Diaper”. By this, the hydration status is measured by assessing the properties of the urine output, which is recorded in the device.

Study Design              –         Prospective Study

Study Setting             –          Public Healthcare Centers

Sample Size                –         Total n=50

Selection Criteria

• Inclusion –          Healthy children of both genders between the age group of 1 and 3
• Exclusion –          Children with fevers, pathological and systemic conditions
  –          Children who are still being breastfed (Manz, 2007)

Materials Required

1. Smart diapers
2. Data forms for noting down the findings

Data Analysis

The data collected from the memory of the IC within the Smart diaper would be noted down in the data forms. As the data would have been taken for 3 consecutive days, the average data shall be taken into consideration. The output would be analyzed by age (month group), gender, and diet of the child, which is reported by the parents of the child. A comparison of the data obtained with standardized normative data shall be made, and any data that falls out of the normative range shall be highlighted.

Ethical Considerations

This study was proposed to the Research Ethics and Administration committee of the university, and the necessary ethical clearances were received. The mandatory permissions to perform the study in selected settings were requested. (Miller, 2012) All individuals (parents of the children), upon being selected for the study, would be provided with an information sheet which would contain the research procedure, following which the procedure would be explained verbally. It would be up to the discretion of the selected individuals to accept or reject the invitation to participate in this study. Upon acceptance, the participants would be asked to fill a written consent form, confirming their voluntary participation in the research. All information that would be obtained from every individual would be kept in high confidentiality. All financial costs that would be incurred on the course of the study would be borne completely by the researcher, with no compensation of any kind being given to any participant.

Administration of the Research

The research process will be administered by the student. Every participant would receive a set of smart diapers, which they would use on their child for three consecutive nights. The findings of the urine properties that would be displayed on the display screen of the accompanying device shall be noted. AT the end of the three days, the readings shall be noted, and the properties of urine which is recorded shall be matched with normative values. The parents of the children whose normative values fall short of, or exceed the benchmark shall be notified accordingly, thus preventing any major health issue in the future.

The parameters to be noted down by the parent is the colour, volume, and frequency of urine that has been passed, the type of diet taken in by the child on all the three days, any medication or booster supplements taken, and any signs of fever in the child. The overall costs of the procedure include the costs of the Smart diapers, which would come around 10 USD per diaper, (Simik et al., 2015) and the printing costs of the consent forms and data forms.

Expected Outcomes/Implications for Practice

The expected outcome of this study is to register a positive outcome, with the majority of children showing signs of proper hydration. However, in children showing altered urination pattern and values, it is essential to educate the parents on the importance of immediate medical consultation. If the alterations are due to improper hydration, then it is essential to focus on the importance of hydration and the seriousness of slow dehydration (Shortliffe & McCue, 2002). An awareness program on the importance of proper hydration in children is essential, as it would lead to avoiding sugary drinks, and increasing the intake of adequate amounts of water in one’s diet. The use of a smart diaper with sensor technology will go a long way as an effective screening to check the hydration status in children.

Limitations of the Study

This study is focused on children below the age of 3, which means that their toilet training is not complete, and they tend to wet their bed at night. By this, one can get the hydration status of a toddler whose food habits are not yet completely developed, but relies on child food. The findings at this age need not necessarily reflect the hydration status at a later age, when the children grow up to eat solid food in their diet (Stahl et al., 2007). Another limitation of this study is that there are only 50 children taken as samples. This is an insignificant number, compared to the population size of infants in the locality. However, as it is a student project, it can be taken into consideration.

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