The Mobile App to Assist with Tattoo-encoded Baby Immunization Records in Africa

"Tattoos, the design element (which have survived throughout Africa's long cultural tradition), are reborn as a symbol of children's lives being saved..."

This paper describes the design and implementation of a mobile application (app) that assists with the interpretation and generation of tattoos that encode immunisation records. It examines how ethnographic research and design - in the form of the "tattoo of Africa" concept, reflective of African cultural backgrounds and linked with the health service design process - can be used to address issues plaguing the vaccination system for children in Africa. In the project, tattoos, which have been common in Africa for thousands of years, have been redefined as a new ritual for child health records.

As the researchers explain, ethnography strengthens design by exposing the user's surrounding environment and drawing out the understanding of cultural implications and primary users. Ethnography can be useful in helping designers find the communication strategy or insight required for a plan, method, or composition; it has been widely applied in all areas of HCI (Human-Computer Interaction), for example.

West African symbols known as Adinkra connote various meanings. They have a decorative function but also represent objects that encapsulate evocative messages that convey traditional wisdom and aspects of life or the environment. Therefore, within the context of African culture, the researchers identified tattoos as a design element that is associated with improvement and empowerment. The concept of the tattoo can be used as a unique identifier that is intimately connected to the child. It can also be a simple but powerful educational tool for families to learn more about health interventions. It can be a source of information for health workers about the child's health and vaccination status, and what the child needs at each point of contact with the health system. It can also be a source of information for the household surveyor, whom many countries and policymakers rely on to validate coverage levels obtained from administrative data systems.

The tattoo composition consists of one umbilical cord (representing the transfer of oxygen and nutrients) and 5 leaf elements (the sprout being a symbol of an infant). The umbilical cord symbol is tattooed on the baby's skin after being given the vaccinations: Bacille Calmette-Guérin (BCG), hepatitis B (HepB), oral polio vaccine (OPV), and OPV1. After this, each additional leaf symbol indicates vaccinations at 6 weeks, 10 weeks, 14 weeks, 9-12 months, and 15-18 months. Families can personalise their own tattoos by adjusting the composition of the leaf elements in various ways.

This design is applied to 2 different artifacts:

• A baby guidebook - The researchers have created a visualisation featuring the tatoo to be included in the paper-based personal child health record given to every parent. The typography used on the cover page has been designed to make the written vaccine information legible, readable, and appealing. Details can be recorded in the pages of the book. That design can also be applied to a web-based digital type of book.
• A baby bracelet that includes both physical and digital elements - On the one hand, the bracelet is physically "tattooed" - that is, the growing tree of life is physically painted on the bracelet itself. Thus, it can be read and understood without any technology. The hope is that both families and doctors will easily interpret the symbol and will know the vaccination status of every child (the vaccines administered to him or her) just by looking at the bracelet. On the other hand, the bracelet contains a Near Field Communication (NFC) tag, which stores more complete information about the child's vaccination status (including dates). The information can be read from or written to any NFC-enabled Android smartphone via the visual interface of the related app. (When a phone is near an NFC tag, the electromagnetic field from the phone provides the power to fire up the NFC tag. Since NFC tags are unpowered circuits, they do not require batteries.)

The researchers have designed and developed a prototype, which they describe in the paper. In short, the app has been designed in order to simplify the interaction of doctors and families with the information stored on the NFC bracelet (a formatted text string containing vaccine identifiers and the dates when the vaccinations were given). There are 2 versions of the app: one for doctors and another for families. When a smartphone (with the prototype app installed) is located very near the prototype NFC bracelet, the app is automatically launched, and its main screen appears. It shows the whole symbol (tattoo) design. The parts of the tattoo corresponding to vaccines already administered appear clearly in a dark colour, while the other parts (corresponding to vaccines still not administered) appear in a light colour. By touching any leaf of the tattoo symbol, the app shows the information corresponding to the related vaccine; the app also warns users when a vaccination date approaches.

With follow-up research, the researchers plan (in collaboration with non-governmental organisations - NGOs) to conduct user research and experiments on the prototype with local children, parents, and health workers.