JOOTRH introduces Bili Ruler for non-invasive neonatal jaundice screening

KENYA—The Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH)  has introduced a breakthrough diagnostic tool, the Bili Ruler, a non-invasive device designed to detect jaundice in newborns early and reduce neonatal mortality.

This low-cost innovation marks a significant step forward in addressing a persistent health challenge in regions where laboratory equipment remains inaccessible to many healthcare facilities.

A growing health crisis in Africa

Neonatal jaundice is characterized by the yellowing of a baby’s skin and eyes, ranking among the world’s leading causes of infant death and disability.

In sub-Saharan Africa, the problem becomes even more critical, with untreated jaundice-related complications responsible for up to 80 percent of neonatal deaths.

Kevin Kasadhe, a clinical research nurse and trainer at the Kenya Medical Research Institute (KEMRI), emphasizes that jaundice ranks seventh among the region’s leading causes of newborn mortality.

The hospital serves as a primary research site for the PRISMA study (Pregnancy Risk, Infant Surveillance and Measurement Alliance), which aims to establish a roadmap for nationwide expansion across Kenya.

Researchers have partnered with the device to tackle jaundice diagnosis, where traditional blood tests fail to reach vulnerable populations.

A better way to diagnose

Historically, doctors diagnosed jaundice through Total Serum Bilirubin (TSB) testing, a procedure requiring blood draws from infants—costly, invasive, and often unavailable in smaller health facilities.

The Bili Ruler eliminates this obstacle by applying gentle pressure to a baby’s nose; healthcare workers observe color changes through transparent windows, providing instant visual results without needles or laboratory equipment.

To ensure accuracy among populations with darker skin tones, researchers paired the ruler with the Monk Skin Tone scale.

Kasadhe notes that African populations’ natural pigmentation can complicate visual jaundice detection.

This additional tool allows clinicians to correlate ruler findings with individual skin tone, preventing cases from being overlooked due to pigmentation differences.

Early Results Demonstrate Success

Since launching on January 13, 2025, the study has enrolled 2,703 participants across its pregnancy surveillance platform, with 930 children specifically participating in the Bili Ruler sub-study.

Most significantly, the intervention has recorded zero jaundice-related deaths among identified cases, thanks to early detection and swift referrals for treatment.

The research spans six facilities across Kisumu and Siaya counties, including JOOTRH, Kisumu County Referral Hospital, Siaya County Referral Hospital, and three additional health centers.

Affordability Opens New Possibilities

Priced at approximately Ksh 1,200 (USD 9), the Bili Ruler offers sustainability for Kenya’s Ministry of Health.

Unlike expensive laboratory tests, nurses working in understaffed facilities can operate the device, and community health volunteers could potentially extend screening to mothers who deliver at home.

Healthcare providers monitor infants within 24 hours of birth, at three days, and again at one week, with immediate pediatric referrals triggered when bilirubin levels exceed 15 mg/dL.