Infant mortality Archives - InnoHEALTH magazine

Transforming Maternal and Infant Healthcare: A Vision from Janitri’s Founder, Arun Agarwal

Khushi Khandelwal — Tue, 06 May 2025 10:30:00 +0000

At the InnoHealth Conference 2024, host Mercilina sat down with Mr. Arun Agarwal, the founder of Janitri, a Bangalore-based health tech company revolutionizing maternal and newborn care. With a focus on critical monitoring during pregnancy, labor, and the neonatal period, Janitri is working to prevent maternal and infant mortality through wearable and AI-enabled technology.

A Mission Rooted in Compassion

“Janitri is a Sanskrit word for ‘mother’,” Arun explained. “Our vision is a world where no mother or baby dies during pregnancy, labor, or the newborn phase.” The startup, now eight years into its journey, has partnered with over 600 hospitals and has already impacted the lives of more than 8,000 mothers, monitoring over 150,000 pregnancies.

Janitri focuses on the critical “first thousand days” — from conception to two years after birth — by enabling real-time monitoring of vital signs through wearable devices. These solutions are designed to assist in both hospital and home settings, ensuring that early decisions can be made based on accurate data.

The Ground Reality: Urban vs. Rural Disparities

When asked about the current state of maternal and infant health in India, Arun highlighted a pressing concern. “India sees about 3 crore births annually, but we have only around 50,000 gynecologists,” he said. This stark mismatch in resources creates a heavy reliance on frontline workers like staff nurses and ASHA workers, especially in rural regions.

Statistically, India’s maternal mortality rate stands at approximately 97 per 100,000 live births, while the infant mortality rate is around 29–30 per 1,000 live births. However, these figures vary widely across states and are notably higher in rural areas, where access to emergency interventions like C-sections is limited. “In urban areas, C-sections are often used to prevent complications. But rural settings don’t have that luxury,” Arun noted.

Bridging the Gap with Technology

To address this disparity, Arun believes technology is the most viable and scalable solution. “We cannot bridge the gap with manpower alone, but we can with tech,” he emphasized. Janitri’s wearable devices monitor vital signs during prenatal, labor, and postpartum phases and assist healthcare workers in making timely decisions.

The Indian government is also stepping in with supportive policies. Programs like the Pradhan Mantri Surakshit Matritva Abhiyan and the integration of tech into public healthcare systems (including RCH, previously known as the Mother-Child Tracking System or MCTS) show promise. Arun expressed optimism about India’s growing focus on medtech innovation, which is being bolstered by favorable regulatory policies and investment in medical device manufacturing.

Looking Ahead

Janitri’s approach is not just about building products — it’s about building trust and empowering frontline workers with tools that enable better outcomes. Arun’s grassroots research, which included visits to over 100 hospitals and consultations with healthcare providers and families, shaped the company’s deep understanding of on-the-ground challenges.

As the conversation concluded, Arun reiterated Janitri’s core belief: “Many of these maternal and neonatal deaths are preventable. It all comes down to timely monitoring and intervention — and that’s exactly what we’re here to enable.”

Composed By

InnoHEALTH magazine digital team

Listen to the full podcast on our YouTube channel: https://www.youtube.com/watch?v=5waUZP09egk&t=1s

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Social Behavior Modification for Unmet Need of Prevention

InnoHEALTH Magazine — Fri, 01 Nov 2019 06:45:48 +0000

Resource poor communities are unable to afford expensive, supply side solutions for deficiencies in healthcare. Lack of finances, medical manpower, drugs and technology renders poor communities vulnerable to diseases, many of which are either preventable or curable. Unmet needs of preventive care often turn a completely preventable disease into a condition requiring expensive secondary or tertiary care, which further burdens the alreadymeagre resources.

The solution may lie in improving the demand side of the healthcare. Modifying social health behaviour may be the least expensive method to reduce disease burden in a community. Save a Mother (SAM), a healthcare NGO, works on the demand side by embedding in the communities to carry prevention to the doorstep. SAM has developed an Effective Social Persuasion platform (SAM-ESP), a model forsocial behaviour change, which reduces disease burden. In the past 11 years, SAM has successfully replicated the solution in different locations in India.

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Established in 2008, SAM has focussed on five themes: maternal and infant mortality reduction, population stabilization, TB control and malnutrition. SAM has worked with vulnerable communities of 3 million people living in 1800 villages and one urban slum, located in 10 districts of 4 states of India. SAM has shown considerable success in all the programs at all locations. SAM is currently active in five districts.

SAM selects the target population on the following criteria:
Targeting vulnerability: SAM works with the poor and vulnerable communities who lack education, income, assets, status and access to healthcare.
Targeting pregnant, infants and children: SAM follows all pregnant women, infants and children under 5 years in the community.
Targeting reproductive age: For population stabilisation, SAM targets reproductive age group women and married couples between ages 18 and 49 years and adolescent girls from 10 to 19 years.
Targeting disease: SAM targets the families and contacts all TB patients, malnourished children and high-risk pregnant women.
SAM-ESP Innovation: SAM has developed a cost-effective platform for changing health behaviour ofa community. Health activists, in partnership with local public and private healthcare stakeholders, convert awareness to actionable knowledge. SAM has successfully used its Effective Social Persuasion Platform (SAM-ESP) in multiple locations. ESP relies on seven assumptions.
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Behaviour modification is the least expensive way to reduce disease burden.

Health is an individual and community responsibility; ownership of this responsibility empowers a community to demand healthcare rights. A campaign to push health information may improve awareness but is not sufficient by itself. Awareness is just one of many steps to change behaviour. Other essential steps include: a sustained, intensive, repetitive campaign without a predefined end time-point, encouraging peer to peer nudge and a methodical transfer of ownership to the community leaders.

Messages scripted by the community encourages their ownership. Trained volunteer activists can lead and sustain the ESP without external help.

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An established SAM-ESP platform can be used to address multiplehealth problems. SAM-ESP is not yetanother awareness building program. Awareness is often assumed to be equal to behaviour change. In practice, it is not true. Communication programs and prevalent awareness programs merely touch the surface without translating into significant behaviour change. SAM-ESP is a multi-step process, where awareness in just one of many steps for a sustainable behaviour change.

SAM promotes community ownership of both health and healthcare. SAM believes, that health is an individual and community responsibility and getting healthcare, as a right, has to be learned. SAM-ESP is a peoples’ program, which ensures that the health system is responsive and accountable.

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SAM trains volunteer health activists who lead the program and develops a cadre of social entrepreneurs, who sell contraceptives, sanitary pads and nutritional products. SAM field workers are from the community where they live and work. They are available 24/7 and take health to the doorstep of the recipients. The program sets no predetermined end date; repetitive training continues till SAM meets the objectives.

The following steps describe its execution:

Organize, create structure and build leadership capacity: SAM has well-trained field staff and managers;the voluntary directors of the organization are professionals from healthcare and management. Each district has a manager, trainers, and supervisors who are selected from the local population. They receive intensive training not only in health issues but also in motivational techniques, training methods and leadership.

Develop messages: SAM believes that a good message should be simple without technical jargon, short with less than five points, easy to understand without explanation and emotionally connected with a local need. For better retention, a message could be in the form of a story, song or a slogan. Some messages should be created by the community to feel ownership.

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Train health activists: Master trainers train volunteer health activists to be responsible for village health issues. Training is repetitive and intense.

Teach people: SAM organizes the village into a healthcare community. Field supervisors motivate and mobilize villagers and discuss each topic of healthcare with a specific training module. SAM uses local community resources to create training material and health leaders script their own songs and slogans. Activists meet villagers repeatedly to discuss best practices. Repetitive training of health activists and villagers is essential.

Cooperation with public and private health systems: SAM establishes linkage with the local private and public health system. Utilizing all available public health resources is an essential component of the program. Public health workers are invited to all meetings. This linkage creates awareness, which improves demand of healthcare and encourages accountability.

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Evaluation and improvement: Programs are monitored by community involvement and by participatory research action. Results lead tocourse correction.
Replicate: Solutions are validated and replicated in other locations.

Measuring impact: Each program starts with a baseline and finishes with an end-line evaluation. SAM defines objectives, activities, outputs and outcomes before the start of the program. They measure monthly progress against all these parameters.

Process of measuring impact is a four-step process:
Data Collection at community level: The field workers collect data during house visits and community meetings. They upload it on a smartphone.
Data review at block level: Field officers collate and review data every month at a block level. They validate it through client interaction.

Data validation at district level: SAM validates data through a monitor and evaluation protocol which includes field visits, focus groups and comparison with public health data. SAM compares outcomes and impact with similar programs run by the government and other private organisations.

External agency evaluation: Periodically, SAM engages external agencies to evaluate its work. The funding partners also send external evaluators to check the progress and impact.

Direct impact: Since inception, SAM has trained 37,000 volunteer health activists who live in the villages and are available to the community. SAM has directly impacted over 1,150,000 million people through maternal, child health, population stabilisation and TB control programs.

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Through maternal, child health and population stabilization programs, SAM has directly impacted: 530,000 women and over approximately 100,000 infants. SAM follows all (100%) pregnant women in the villages and has reduced maternal mortality by 90% and infant mortality by 60%. In some places, SAM has done even better. In the past 6 years, in 167 villages of Gadag, Karnataka; maternal mortality rate has decreased to 15.8 from 364 and the Infant mortality rate has decreased to 5 from 46.

Through population stabilizations program, the marriage of girls under 18 years of age has decreased to almost zero. Contraceptive use has increased from 28% to 62% and supplychain management has reduced the unmet need for contraception from 10.8 % to 2% been running in 700 villages. 287,042 people have participated in 14,552 community meetings. 13,973 people have had sputum tested. Sputum was positive for TB in 1329 people and 14 had multiple drug resistant TB. All received supervised treatment. SAM has directly helped with education and surveillance of 130,000 contacts of TB patients and helped another 317,000 community members with awareness program. TB detection rate has improved 3.7 times.

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Indirect impact: SAM estimates that approximately 0.9 to 1 million people, who did not actively participate in its programs, became aware of the benefits from those who attended our programs.

Women feel empowered, which has opened their minds to many choices in life. They express their opinions freely. Men and elderly women, who were suspicious and objected to their women attending public meetings, have mellowed their resistance and have even become enablers. Girls attend school more regularly and the number of girls attending college has increased. Adolescents participation has increased. Public health system and their workers are more responsive to public demand.Local elected politicians are responsive.

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Discussion: Multiple theories have attempted to explain the health behaviour of individuals. The most popular is the Health Belief Model (HBM), which was developed about 40 years back. It postulates that people make healthcare decisions based on perceived susceptibility to disease and consequences. The response is tempered by perceived benefits of action and with a belief that benefits outweigh risks. While this theory, like other theories, builds a plausible reference point to explain behaviour, it gives no guidance for modification of individual behaviour.

Theory of Planned Behaviour suggests that a person should be empowered with ability (self-efficacy) to change behaviour. The person should believe that the behaviour will improve his health and is socially approved. It has also been recommended that principles of marketing could be applied to a social cause, where the product to be sold is behaviour change.

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SAM model comes close to a hybrid variety of HBM, building self-efficacy and social marketing. SAM tries todevelop social efficacy through the agency of health activists by using techniques similar to social marketing. SAM Effective Social Persuasion is a people’s platform, which needs further elucidation and expansion. SAM is looking to use entertainment education or gamification for behaviour modification and use of technology in early detection of noncommunicable diseases. SAM seeks collaboration with others for mutual learning, sharing resources and scaling-up the program in vulnerable population.

About the author

Dr. Shiban Ganju is the Chairman of Atrimed Pharmaceuticals and Founder of Save A Mother Foundation, USA. He has dedicated his life to healthcare. Dr. Ganju graduated from AIIMS New Delhi and received advanced training in Internal Medicine and Gastroenterology both in India and USA. He is a consultant specializing in gastroenterology, liver disease and nutrition in hospitals in the greater Chicago area. His commitment to and understanding of how to drive improvements in health outcomes has benefitted big strata of society.

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Iron and Zinc Deficiencies can be Addressed

InnoHEALTH Magazine — Thu, 10 May 2018 10:57:28 +0000

Simple measures Iron zinc deficiencies

India is one of the leading exporters of cereals. It is the second largest producer of rice and fruits in the world. Overall, the country is self-sufficient in food production. Yet iron and zinc deficiencies are widespread even amongst well-nourished children.

A recent study has found that it could be because cereals, tubers, and legumes, which are the major constituents of a staple diet, contained a class of substances called phytates in high amounts. Phytates are considered ‘anti-nutrient’ as they attach themselves to the iron and zinc in the food. And make them unavailable to the body for its use. This low ‘bioavailability’ is the main cause of deficiency of iron and zinc in the Indian population.

But, one should not eliminate the phytates from the diet. Phytates help in fighting off cancer and age-related changes in the body.

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The researchers have recommended modifying eating habits and cooking practices. South Indian cooking, for instance, follows a process of fermentation, soaking, and germination which reduces the phytate content. Likewise, a simple intervention such as taking a piece of guava or Indian gooseberry (amla) fruit after food or while taking iron tablets would double the availability of iron and zinc in the body.

In addition, they suggest, measures like minimal milling, intake of vitamin C, heating, and enzymatic treatment of grains with phytates enzyme and consuming curds, yogurts, and probiotic cultures to maintain an acid environment in the gut as well as genetic improvement of food crops may enhance bioavailability of iron and zinc. Further, non-vegetarian foods can also make available more iron and zinc to the body.

The study, conducted by researchers at Indian Institute of Horticultural Research, Bengaluru, has found that the country as a whole requires 8,170 tonnes of iron and 4,412 tonnes of zinc in the food to meet nutritional iron and zinc requirements of the entire population. Availability of iron from the plant and animal food sources is estimated at 10,939 tonnes per year and that of zinc at 6,335 tonnes per year. In other words, there is enough supply of iron and zinc through food sources in the country. The intake of the two micronutrients is also adequate.

Agricultural crops such as cereals, pulses, oilseeds, and sugar contribute the major share of the requirements, at 82.8% for iron and 78.6% for zinc. This is followed by the animal husbandry sector, including milk and milk products, meat, mutton, beef, pork, chicken, and eggs, which account for 3.9% iron and 11.7% zinc. The horticultural sector (including fruits, vegetables, and nuts) contributes 12.9% iron and 9.1% zinc to national production. The fisheries sector is at the tail end, providing 0.42% iron and 0.62% zinc.

The researchers have published a report on the study in a recent issue of journal Current Science.

Dr A.N. Ganeshamurthy, leader of the research team, said, “There was a need for research efforts to focus on methods to reduce phytate content of Indian foods to enhance bioavailability. This should be at the forefront of nutritional programmes rather than trying to improve the quality or yield of crops.

“Before a new variety is released for farming by a breeder, the Institute/State/National-level variety release committees must take into account the issue of absorption of iron and zinc. Efforts to improve the quality and yield of crops or the ‘biofortification programmes’ will prove to be a failure if they do not address the issue of bioavailability of nutrients. Furthermore, we must do all we can to ensure a healthy soil and a healthy production environment with good agricultural practices,” he added.

Iron deficiency, which may or may not result in anaemia, leads to a substantial loss in physical productivity in adults. Iron deficiency associated with maternal mortality, pre-term labor, low birth weight and infant mortality. In children, it affects development and increases the likelihood of sickness. The highest prevalence of anaemia is seen in children around 15 years of age, in pregnant women and elderly people. Zinc deficiency, in turn, may cause hair loss, affect the taste and smell, among other things.

Dr Ganeshamurthy conducted the study in collaboration with his colleagues, Dr D. Kalaivanan and Dr B. L. Manjunath.

(Shared from India Science Wire)

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