Cargando…

The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial

BACKGROUND: The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda relies on a robust community health worker (CHW)–led, home-based paradigm for delivering f...

Descripción completa

Detalles Bibliográficos
Autores principales: Kateera, Fredrick, Riviello, Robert, Goodman, Andrea, Nkurunziza, Theoneste, Cherian, Teena, Bikorimana, Laban, Nkurunziza, Jonathan, Nahimana, Evrard, Habiyakare, Caste, Ntakiyiruta, Georges, Matousek, Alexi, Gaju, Erick, Gruendl, Magdalena, Powell, Brittany, Sonderman, Kristin, Koch, Rachel, Hedt-Gauthier, Bethany
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9218905/
https://www.ncbi.nlm.nih.gov/pubmed/35675108
http://dx.doi.org/10.2196/35155
_version_ 1784731998864015360
author Kateera, Fredrick
Riviello, Robert
Goodman, Andrea
Nkurunziza, Theoneste
Cherian, Teena
Bikorimana, Laban
Nkurunziza, Jonathan
Nahimana, Evrard
Habiyakare, Caste
Ntakiyiruta, Georges
Matousek, Alexi
Gaju, Erick
Gruendl, Magdalena
Powell, Brittany
Sonderman, Kristin
Koch, Rachel
Hedt-Gauthier, Bethany
author_facet Kateera, Fredrick
Riviello, Robert
Goodman, Andrea
Nkurunziza, Theoneste
Cherian, Teena
Bikorimana, Laban
Nkurunziza, Jonathan
Nahimana, Evrard
Habiyakare, Caste
Ntakiyiruta, Georges
Matousek, Alexi
Gaju, Erick
Gruendl, Magdalena
Powell, Brittany
Sonderman, Kristin
Koch, Rachel
Hedt-Gauthier, Bethany
author_sort Kateera, Fredrick
collection PubMed
description BACKGROUND: The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda relies on a robust community health worker (CHW)–led, home-based paradigm for delivering follow-up care for women after childbirth. However, this program does not currently include postoperative care for women after c-section, such as SSI screenings. OBJECTIVE: This trial assesses whether CHW’s use of a mobile health (mHealth)–facilitated checklist administered in person or via phone call improved rates of return to care among women who develop an SSI following c-section at a rural Rwandan district hospital. A secondary objective was to assess the feasibility of implementing the CHW-led mHealth intervention in this rural district. METHODS: A total of 1025 women aged ≥18 years who underwent a c-section between November 2017 and September 2018 at Kirehe District Hospital were randomized into the three following postoperative care arms: (1) home visit intervention (n=335, 32.7%), (2) phone call intervention (n=334, 32.6%), and (3) standard of care (n=356, 34.7%). A CHW-led, mHealth-supported SSI diagnostic protocol was delivered in the two intervention arms, while patients in the standard of care arm were instructed to adhere to routine health center follow-up. We assessed intervention completion in each intervention arm and used logistic regression to assess the odds of returning to care. RESULTS: The majority of women in Arm 1 (n=295, 88.1%) and Arm 2 (n=226, 67.7%) returned to care and were assessed for an SSI at their local health clinic. There were no significant differences in the rates of returning to clinic within 30 days (P=.21), with high rates found consistently across all three arms (Arm 1: 99.7%, Arm 2: 98.4%, and Arm 3: 99.7%, respectively). CONCLUSIONS: Home-based post–c-section follow-up is feasible in rural Africa when performed by mHealth-supported CHWs. In this study, we found no difference in return to care rates between the intervention arms and standard of care. However, given our previous study findings describing the significant patient-incurred financial burden posed by traveling to a health center, we believe this intervention has the potential to reduce this burden by limiting patient travel to the health center when an SSI is ruled out at home. Further studies are needed (1) to determine the acceptability of this intervention by CHWs and patients as a new standard of care after c-section and (2) to assess whether an app supplementing the mHealth screening checklist with image-based machine learning could improve CHW diagnostic accuracy. TRIAL REGISTRATION: ClinicalTrials.gov NCT03311399; https://clinicaltrials.gov/ct2/show/NCT03311399
format Online
Article
Text
id pubmed-9218905
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher JMIR Publications
record_format MEDLINE/PubMed
spelling pubmed-92189052022-06-24 The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial Kateera, Fredrick Riviello, Robert Goodman, Andrea Nkurunziza, Theoneste Cherian, Teena Bikorimana, Laban Nkurunziza, Jonathan Nahimana, Evrard Habiyakare, Caste Ntakiyiruta, Georges Matousek, Alexi Gaju, Erick Gruendl, Magdalena Powell, Brittany Sonderman, Kristin Koch, Rachel Hedt-Gauthier, Bethany JMIR Mhealth Uhealth Original Paper BACKGROUND: The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda relies on a robust community health worker (CHW)–led, home-based paradigm for delivering follow-up care for women after childbirth. However, this program does not currently include postoperative care for women after c-section, such as SSI screenings. OBJECTIVE: This trial assesses whether CHW’s use of a mobile health (mHealth)–facilitated checklist administered in person or via phone call improved rates of return to care among women who develop an SSI following c-section at a rural Rwandan district hospital. A secondary objective was to assess the feasibility of implementing the CHW-led mHealth intervention in this rural district. METHODS: A total of 1025 women aged ≥18 years who underwent a c-section between November 2017 and September 2018 at Kirehe District Hospital were randomized into the three following postoperative care arms: (1) home visit intervention (n=335, 32.7%), (2) phone call intervention (n=334, 32.6%), and (3) standard of care (n=356, 34.7%). A CHW-led, mHealth-supported SSI diagnostic protocol was delivered in the two intervention arms, while patients in the standard of care arm were instructed to adhere to routine health center follow-up. We assessed intervention completion in each intervention arm and used logistic regression to assess the odds of returning to care. RESULTS: The majority of women in Arm 1 (n=295, 88.1%) and Arm 2 (n=226, 67.7%) returned to care and were assessed for an SSI at their local health clinic. There were no significant differences in the rates of returning to clinic within 30 days (P=.21), with high rates found consistently across all three arms (Arm 1: 99.7%, Arm 2: 98.4%, and Arm 3: 99.7%, respectively). CONCLUSIONS: Home-based post–c-section follow-up is feasible in rural Africa when performed by mHealth-supported CHWs. In this study, we found no difference in return to care rates between the intervention arms and standard of care. However, given our previous study findings describing the significant patient-incurred financial burden posed by traveling to a health center, we believe this intervention has the potential to reduce this burden by limiting patient travel to the health center when an SSI is ruled out at home. Further studies are needed (1) to determine the acceptability of this intervention by CHWs and patients as a new standard of care after c-section and (2) to assess whether an app supplementing the mHealth screening checklist with image-based machine learning could improve CHW diagnostic accuracy. TRIAL REGISTRATION: ClinicalTrials.gov NCT03311399; https://clinicaltrials.gov/ct2/show/NCT03311399 JMIR Publications 2022-06-08 /pmc/articles/PMC9218905/ /pubmed/35675108 http://dx.doi.org/10.2196/35155 Text en ©Fredrick Kateera, Robert Riviello, Andrea Goodman, Theoneste Nkurunziza, Teena Cherian, Laban Bikorimana, Jonathan Nkurunziza, Evrard Nahimana, Caste Habiyakare, Georges Ntakiyiruta, Alexi Matousek, Erick Gaju, Magdalena Gruendl, Brittany Powell, Kristin Sonderman, Rachel Koch, Bethany Hedt-Gauthier. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 08.06.2022. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on https://mhealth.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Kateera, Fredrick
Riviello, Robert
Goodman, Andrea
Nkurunziza, Theoneste
Cherian, Teena
Bikorimana, Laban
Nkurunziza, Jonathan
Nahimana, Evrard
Habiyakare, Caste
Ntakiyiruta, Georges
Matousek, Alexi
Gaju, Erick
Gruendl, Magdalena
Powell, Brittany
Sonderman, Kristin
Koch, Rachel
Hedt-Gauthier, Bethany
The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial
title The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial
title_full The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial
title_fullStr The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial
title_full_unstemmed The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial
title_short The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial
title_sort effect and feasibility of mhealth-supported surgical site infection diagnosis by community health workers after cesarean section in rural rwanda: randomized controlled trial
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9218905/
https://www.ncbi.nlm.nih.gov/pubmed/35675108
http://dx.doi.org/10.2196/35155
work_keys_str_mv AT kateerafredrick theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT riviellorobert theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT goodmanandrea theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT nkurunzizatheoneste theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT cherianteena theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT bikorimanalaban theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT nkurunzizajonathan theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT nahimanaevrard theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT habiyakarecaste theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT ntakiyirutageorges theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT matousekalexi theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT gajuerick theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT gruendlmagdalena theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT powellbrittany theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT sondermankristin theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT kochrachel theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT hedtgauthierbethany theeffectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT kateerafredrick effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT riviellorobert effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT goodmanandrea effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT nkurunzizatheoneste effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT cherianteena effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT bikorimanalaban effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT nkurunzizajonathan effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT nahimanaevrard effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT habiyakarecaste effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT ntakiyirutageorges effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT matousekalexi effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT gajuerick effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT gruendlmagdalena effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT powellbrittany effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT sondermankristin effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT kochrachel effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial
AT hedtgauthierbethany effectandfeasibilityofmhealthsupportedsurgicalsiteinfectiondiagnosisbycommunityhealthworkersaftercesareansectioninruralrwandarandomizedcontrolledtrial