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Kateera F, Riviello R, Goodman A, Nkurunziza T, Cherian T, Bikorimana L, Nkurunziza J, Nahimana E, Habiyakare C, Ntakiyiruta G, Matousek A, Gaju E, Gruendl M, Powell B, Sonderman K, Koch R, Hedt-Gauthier B. The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e35155. [PMID: 35675108 PMCID: PMC9218905 DOI: 10.2196/35155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 12/02/2022] Open
Abstract
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
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Affiliation(s)
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States
| | - Andrea Goodman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Theoneste Nkurunziza
- Partners in Health, Kigali, Rwanda
- Epidemiology, Department for Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Teena Cherian
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | | | | | | | | | - Alexi Matousek
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
| | - Erick Gaju
- Rwanda Ministry of Health, Kigali, Rwanda
| | - Magdalena Gruendl
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
- Epidemiology, Department for Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Brittany Powell
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
| | - Kristin Sonderman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
| | - Rachel Koch
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bethany Hedt-Gauthier
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Starr N, Gebeyehu N, Tesfaye A, Forrester JA, Bekele A, Bitew S, Wayessa E, Weiser TG, Negussie T. Value and Feasibility of Telephone Follow-Up in Ethiopian Surgical Patients. Surg Infect (Larchmt) 2020; 21:533-539. [PMID: 32301651 DOI: 10.1089/sur.2020.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Surgical site infections (SSIs) represent a major cause of morbidity and mortality in Ethiopia. Lack of post-discharge follow-up, including identification of SSIs, is a barrier to continued patient care, often because of financial and travel constraints. As part of a surgical quality improvement initiative, we aimed to assess patient outcomes at 30 days post-operative with a telephone call. Patients and Methods: We conducted mobile telephone follow-up as part of Lifebox's ongoing Clean Cut program, which aims to improve compliance with intra-operative infection prevention standards. One urban tertiary referral hospital and one rural district general hospital in Ethiopia were included in this phase of the study; hospital nursing staff called patients at 30 days post-operative inquiring about signs of SSIs, health-care-seeking behavior, and treatments provided if patients had any healthcare encounters since discharge. Results: A total of 701 patients were included; overall 77% of patients were reached by telephone call after discharge. The rural study site reached 362 patients (87%) by telephone; the urban site reached 176 patients (62%) (p < 0.001). Of the 39 SSIs identified, 19 (49%) were captured as outpatient during the telephone follow-up (p < 0.001); 22 (34%) of all complications were captured following discharge (p < 0.001). Telephone follow-up improved from 65%-78% in the first half of project implementation to 77%-89% in the second half of project implementation. Conclusion: Telephone follow-up after surgery in Ethiopia is feasible and valuable, and identified nearly half of all SSIs and one-third of total complications in our cohort. Follow-up improved over the course of the program, likely indicating a learning curve that, once overcome, is a more accurate marker of its practicability. Given the increasing use of mobile telephones in Ethiopia and ease of implementation, this model could be practical in other low-resource surgical settings.
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Affiliation(s)
- Nichole Starr
- Department of Surgery, University of California San Francisco, San Francisco, California, USA.,Lifebox Foundation, Boston, Massachusetts, USA
| | | | | | - Jared A Forrester
- Lifebox Foundation, Boston, Massachusetts, USA.,Department of Surgery, Stanford University, Stanford, California, USA
| | - Abebe Bekele
- Department of Surgery, Black Lion Hospital, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Surgery, University of Global Health Equity, Kigali, Rwanda
| | | | - Ebisa Wayessa
- Department of Surgery, Fitche General Hospital, Fitche, Ethiopia
| | - Thomas G Weiser
- Lifebox Foundation, Boston, Massachusetts, USA.,Department of Surgery, Stanford University, Stanford, California, USA.,Department of Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
| | - Tihitena Negussie
- Department of Surgery, Black Lion Hospital, Addis Ababa University, Addis Ababa, Ethiopia
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Laing S, Remmelzwaal K, Cooper M, N'Dow J. Mobile Telephone Follow-Up to Ascertain Birth Outcomes in The Gambia. Telemed J E Health 2020; 26:1363-1367. [PMID: 31976821 PMCID: PMC7698643 DOI: 10.1089/tmj.2019.0119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: In the past decade, mobile telephone use has surged in sub-Saharan Africa, creating new opportunities in health care. Mobile telephone interventions have been used in controlled trials to improve perinatal care, but in this first cohort study of birth outcomes from The Gambia, we report the value of mobile telephone follow-up. Methods: Between December 2012 and November 2015, 1,611 women entered the cohort at their first antenatal visit to be followed through pregnancy and beyond. Potential risk factors for adverse birth outcomes were measured throughout the pregnancy. As many women left the health center within a few hours of delivery, delivered elsewhere, or failed to attend the postnatal clinics, mobile telephone follow-up was used to identify stillbirths and neonatal deaths at 7 and 28 days. Results: The immediate birth outcome was known for 968 women who delivered at the health center (60.1%). The known outcomes at birth improved from 60.1% to 85.2% following telephone calls to women who delivered elsewhere. The known outcomes at 7 days improved from 43.6% to 82.5%, and the known outcomes at 28 days improved from 32.8% to 71.5% following a telephone call. Conclusions: Previous cohort studies of birth outcomes in sub-Saharan Africa have not followed the mothers and babies after leaving the birth facility. This cohort is the first to record birth outcomes up to 28 days after the birth. Mobile telephone communications have made an invaluable contribution in intervention studies. This study has shown that mobile telephone follow-up is also an important tool in an observational study.
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Affiliation(s)
- Susan Laing
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom
| | - Karin Remmelzwaal
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom
| | - Max Cooper
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
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Laytin AD, Seyoum N, Azazh A, Zewdie A, Juillard CJ, Dicker RA. Feasibility of telephone-administered interviews to evaluate long-term outcomes of trauma patients in urban Ethiopia. Trauma Surg Acute Care Open 2018; 3:e000256. [PMID: 30588508 PMCID: PMC6280902 DOI: 10.1136/tsaco-2018-000256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Little is known about long-term functional outcomes of trauma patients in low-income and middle-income countries. In sub-Saharan Africa most studies of injury only collect data through emergency department disposition or hospital discharge, and methods of collecting long-term data are subject to significant bias. With the recent increase in access to mobile telephone technology, we hypothesized that structured, telephone-administered interviews now offer a feasible means to collect data about the long-term functional outcomes of trauma patients in urban Ethiopia. Methods We piloted a telephone-administered interview tool based on the Glasgow Outcome Scale-Extended. Using departmental logbooks, 400 consecutive patients presenting to two public referral hospitals were identified retrospectively. Demographics, injury data, and telephone numbers were collected from medical records. When a telephone number was available, patients or their surrogates were contacted and interviewed 6 months after their injuries. Results We were able to contact 47% of subjects or their surrogates, and 97% of those contacted were able and willing to complete an interview. At 6-month follow-up, 22% of subjects had significant persistent functional disability. Many injuries had an ongoing financial impact, with 17% of subjects losing or changing jobs, 18% earning less than they had before their injuries, and 16% requiring ongoing injury-related medical care. Lack of documented telephone numbers and difficulty contacting subjects at recorded telephone numbers were the major obstacles to data collection. Language barriers and respondents’ refusal to participate in the study were not significant limitations. Discussion In urban Ethiopia, many trauma patients have persistent disability 6 months after their injuries. Telephone-administered interviews offer a promising method of collecting data about the long-term trauma outcomes, including functional status and the financial impact of injury. These data are invaluable for capacity building, quality improvement efforts, and advocacy for injury prevention and trauma care. Level of evidence III, retrospective cohort study.
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Affiliation(s)
- Adam D Laytin
- Center for Global Surgical Studies, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Nebyou Seyoum
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aklilu Azazh
- Department of Emergency Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayalew Zewdie
- Department of Emergency Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Catherine J Juillard
- Center for Global Surgical Studies, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Rochelle A Dicker
- Center for Global Surgical Studies, Department of Surgery, University of California San Francisco, San Francisco, California, USA
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Sonderman KA, Nkurunziza T, Kateera F, Gruendl M, Koch R, Gaju E, Habiyakare C, Matousek A, Nahimana E, Ntakiyiruta G, Riviello R, Hedt-Gauthier BL. Using mobile health technology and community health workers to identify and refer caesarean-related surgical site infections in rural Rwanda: a randomised controlled trial protocol. BMJ Open 2018; 8:e022214. [PMID: 29739786 PMCID: PMC5942430 DOI: 10.1136/bmjopen-2018-022214] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Surgical site infections (SSIs) are a significant cause of morbidity and mortality in low-income and middle-income countries, where rates of SSIs can reach 30%. Due to limited access, there is minimal follow-up postoperatively. Community health workers (CHWs) have not yet been used for surgical patients in most settings. Advancements in telecommunication create an opportunity for mobile health (mHealth) tools to support CHWs. We aim to evaluate the use of mHealth technology to aid CHWs in identification of SSIs and promote referral of patients back to healthcare facilities. METHODS AND ANALYSIS Prospective randomised controlled trial conducted at Kirehe District Hospital, Rwanda, from November 2017 to November 2018. Patients ≥18 years who undergo caesarean section are eligible. Non-residents of Kirehe District or patients who remain in hospital >10 days postoperatively will be excluded. Patients will be randomised to one of three arms. For arm 1, a CHW will visit the patient's home on postoperative day 10 (±3 days) to administer an SSI screening protocol (fever, pain or purulent drainage) using an electronic tablet. For arm 2, the CHW will administer the screening protocol over the phone. For both arms 1 and 2, the CHW will refer patients who respond 'yes' to any of the questions to a health facility. For arm 3, patients will not receive follow-up care. Our primary outcome will be the impact of the mHealth-CHW intervention on the rate of return to care for patients with an SSI. ETHICS AND DISSEMINATION The study has received ethical approval from the Rwandan National Ethics Committee and Partners Healthcare. Results will be disseminated to Kirehe District Hospital, Rwanda Ministry of Health, Rwanda Surgical Society, Partners In Health, through conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03311399.
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Affiliation(s)
- Kristin A Sonderman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Magdalena Gruendl
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Koch
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Alexi Matousek
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Bethany L Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Kigali, Rwanda
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Woelber E, Schrick EJ, Gessner BD, Evans HL. Proportion of Surgical Site Infections Occurring after Hospital Discharge: A Systematic Review. Surg Infect (Larchmt) 2016; 17:510-9. [DOI: 10.1089/sur.2015.241] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Erik Woelber
- University of Washington School of Medicine, Seattle, Washington
| | - Emily J. Schrick
- University of Washington College of Arts and Sciences, Seattle, Washington
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Sharma K, Thanbuana BT, Gupta AK, Rajkumari N, Mathur P, Gunjiyal J, Misra MC. A prospective study of wound infection among post-discharge patients at a level 1 trauma centre of India. Indian J Med Microbiol 2016; 34:198-201. [PMID: 27080772 DOI: 10.4103/0255-0857.180299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIM To study the rate of wound infections in the post-discharged patient population and to assess the usefulness of post-discharge surveillance. METHODS A prospective surveillance of all the post-discharged trauma patients was done during a period of 6 months. Discharge instructions were given to all the patients regarding identification of the signs and symptoms of wound infections. They were telephonically followed up after a week to enquire about the wound condition and followed up in the outpatient department (OPD). Microbiology culture samples of those showing any signs and symptoms of infections were sent and their antimicrobial therapy, any change in the treatment schedule and the length of their hospital stay were noted. Factors such as wound class, type of surgeries and readmissions were noted. RESULTS A total of 281 postdischarge patients were enrolled, of which 101 were completely followed up for wound infections. Males were predominant (89%). Of the 101 patients, 42 (41.6%) patients wound showed infection during the intense follow-up in the OPD. However, 59 patients (59/101, 58.4%) showed wound swab culture positivity before discharge. These 42 patients developed signs and symptoms of infection post-discharge; 23 (22.7%) of them had change of antibiotic therapy during the follow-up period due to culture positivity. Acinetobacter sp., Staphylococcus aureus and Klebsiella pneumoniae were the predominant organisms isolated in the study. A total of 45 patients (44.5%) had to be readmitted due to wound site infections. CONCLUSIONS Wound infections are common after discharge among trauma patients highlighting the importance of active surveillance and participation of patients.
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Affiliation(s)
| | | | | | | | - P Mathur
- Department of Laboratory Medicine, Division of Clinical Microbiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Vilas-Boas VA, Mingotte P, Freitas MIPD. Vigilância pós-alta por telefone: validação e aplicação de instrumento para cirurgias vídeo-assistidas. Rev Bras Enferm 2015. [DOI: 10.1590/0034-7167.2015680519i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMOObjetivo:validar instrumento para vigilância pós-alta por contato telefônico de cirurgias vídeo-assistidas.Método:estudo multi-métodos com elaboração, validação e aplicação de instrumento. A validação foi realizada por peritos considerando pertinência, clareza e abrangência do conteúdo, sob cálculo do índice de validade de conteúdo, sendo válidas as questões com 80% de concordância. Para aplicação do instrumento, a amostra foi composta por 68 mulheres submetidas à cirurgia vídeo-assistidas sendo realizada análise descritiva.Resultados:houve discordância entre peritos na primeira avaliação e o instrumento foi reformulado obtendo-se concordância na segunda avaliação. A taxa de resposta ao contato telefônico foi de 88,2% (60/68). Queixas de dor abdominal, sangramento e edema incisional foram mais frequentes. Nenhuma apresentou infecção.Conclusão:o instrumento foi validado, aplicado e encontra-se disponível para utilização.
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