scholarly journals Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting?

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hannah Brown Amoakoh ◽  
Kerstin Klipstein-Grobusch ◽  
Irene Akua Agyepong ◽  
Mary Amoakoh-Coleman ◽  
Gbenga A. Kayode ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Health Workers ◽  
Clinical Decision ◽  
Health Improvement ◽  
Neonatal Health ◽  
Intervention Period ◽  
Protocol Adherence ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

Abstract Background This study assessed health workers’ adherence to neonatal health protocols before and during the implementation of a mobile health (mHealth) clinical decision-making support system (mCDMSS) that sought to bridge access to neonatal health protocol gap in a low-resource setting. Methods We performed a cross-sectional document review within two purposively selected clusters (one poorly-resourced and one well-resourced), from each arm of a cluster-randomized trial at two different time points: before and during the trial. The total trial consisted of 16 clusters randomized into 8 intervention and 8 control clusters to assess the impact of an mCDMSS on neonatal mortality in Ghana. We evaluated health workers’ adherence (expressed as percentages) to birth asphyxia, neonatal jaundice and cord sepsis protocols by reviewing medical records of neonatal in-patients using a checklist. Differences in adherence to neonatal health protocols within and between the study arms were assessed using Wilcoxon rank-sum and permutation tests for each morbidity type. In addition, we tracked concurrent neonatal health improvement activities in the clusters during the 18-month intervention period. Results In the intervention arm, mean adherence was 35.2% (SD = 5.8%) and 43.6% (SD = 27.5%) for asphyxia; 25.0% (SD = 14.8%) and 39.3% (SD = 27.7%) for jaundice; 52.0% (SD = 11.0%) and 75.0% (SD = 21.2%) for cord sepsis protocols in the pre-intervention and intervention periods respectively. In the control arm, mean adherence was 52.9% (SD = 16.4%) and 74.5% (SD = 14.7%) for asphyxia; 45.1% (SD = 12.8%) and 64.6% (SD = 8.2%) for jaundice; 53.8% (SD = 16.0%) and 60.8% (SD = 11.7%) for cord sepsis protocols in the pre-intervention and intervention periods respectively. We observed nonsignificant improvement in protocol adherence in the intervention clusters but significant improvement in protocol adherence in the control clusters. There were 2 concurrent neonatal health improvement activities in the intervention clusters and over 12 in the control clusters during the intervention period. Conclusion Whether mHealth interventions can improve adherence to neonatal health protocols in low-resource settings cannot be ascertained by this study. Neonatal health improvement activities are however likely to improve protocol adherence. Future mHealth evaluations of protocol adherence must account for other concurrent interventions in study contexts.

scholarly journals Integrating Hepatitis B Care and Treatment with Existing HIV Services is Possible: A Cost Minimization Analysis from a Low Resource Setting.

2020 ◽  
Author(s):  
David Livingstone Ejalu ◽  
Joan Nankya Mutyoba ◽  
Claude Wandera ◽  
Emmanuel Seremba ◽  
Andrew Kambugu ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Health Workers ◽  
Clinical Pathways ◽  
Hiv Care ◽  
Cost Minimisation Analysis ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Integrated Pathway ◽  
The Cost

Abstract Background: In recent years there has been growing interest in exploring methods by which the care pathways for people with comorbid physical and health problems may be integrated. The success of such an integration however would depend on several factors including feasibility, acceptability and costs involved. Therefore, this report presents estimated provider costs associated with managing an integrated HBV and HIV clinical pathway for patients on life-long treatment in low resource setting in Uganda.Methods: A cost minimisation analysis from the providers perspective was done by considering financial costs as a measure of the amount of money spent on resources used in the clinical pathways. The annual cost per patient was simulated based on total amount of resources spent for all the patient visits to the facility for HBV or HIV care per year.Results: Findings showed that drugs and laboratory tests were the main drivers of costs in the pathways. A high-volume facility (Arua regional referral hospital- ARRH) had a higher cost per patient in both clinics than did the low volume facility (Koboko District Hospital- KDH). Variations occurred due to differences in the carders of health workers, the infrastructure, the amounts of consumables used in the facilities. Cost per HBV patient was $163.59 in ARRH and $145.76 in K DH while the cost per HIV patient was $176.52 in ARRH and $173.23 in KDH. The integration resulted into total saving of $36.73 per patient per year in Arua RRH and $17.5 in Koboko DH. The cost saving accrued from savings from personnel, fixed costs, consumables and utilities incurred in running the standalone Hepatitis B clinic and the reduction in per HIV patient costs from sharing of resources in the integrated pathway. Conclusion: This analysis showed that the application of the integrated Pathway in HIV and HBV patient management could improve hospital cost efficiency compared to operating stand-alone clinics. This could further improve adherence to treatment by Hepatitis B patients and improve patient outcomes as HBV patients get access to counselling services.

scholarly journals Nursing Care of Low-Risk Newborns in Low Resource Setting: Nurses' Aides May Bridge the Gap at Community Hospitals

2022 ◽  
Vol 3 (1) ◽  
pp. 1-4
Author(s):  
Subhashchandra Daga
Keyword(s):  
Nursing Staff ◽  
Health Workers ◽  
Newborn Care ◽  
Low Resource Settings ◽  
Neonatal Deaths ◽  
Low Resource ◽  
General Duty ◽  
Care Services ◽  
Resource Setting ◽  
Low Resource Setting

Objective: To study the role of a nurses' aide in the care for newborns weighing between 1500 and 2000 g at birth in a low resource setting. Study Design: Observational. Setting: The General hospital in 1994-95, in a public sector, located in a remote area in India Intervention: A female ward assistant with seven years of schooling trained, on-the-job, to keep babies warm, initiate maternal breastfeeding, and to detect rapid breathing. The nursing staff from the pediatric ward supervised her performance. A separate "warm room" appropriately heated for preterm and sick babies became a makeshift nursery. The nursing staff administered enteral feeding, oxygen, and antibiotics. Services of the resident doctors or general duty medical officers were not available. Results: The survival rate was nearly 100% for babies with birthweights between 1,500 and 2,000 g (none referred out). Conclusions: A nurses' aide may facilitate the delivery of special care for newborns where nursing personnel are grossly inadequate and saving babies weighing between 1,500 and 2,000 g may need minimal inputs. It may be worthwhile to target 1,500 and 2,000 g birthweight categories even when resources are meager. What is already known about this subject? Low resource settings face staff shortages, especially nursing staff. Health workers with midwifery skills can deliver nearly 90% of essential care services for maternal and neonatal health. A substantial proportion of neonatal deaths occur among moderately low birth weight babies. What does this study add? It is possible to train a semi-literate person to facilitate early breastfeeding and to keep a baby warm. A large proportion of deaths among babies with birthweight ranging from 1500 to 2000 g are preventable with meager resources. How might this impact on clinical practice or future developments? The facilities facing shortage of nursing staff in low resource settings, may employ nurses’ aide to deliver basic newborn care.

scholarly journals Experience: developing an inpatient malnutrition checklist for children 6 to 59 months to improve WHO protocol adherence and facilitate quality improvement in a low-resource setting

2018 ◽  
Vol 11 (1) ◽  
pp. 1503785
Author(s):  
Kathryn Beck ◽  
Angelique Mukantaganda ◽  
Scheilla Bayitondere ◽  
Richard Ndikuriyo ◽  
Almaque Dushimirimana ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Protocol Adherence ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

Evaluation of a New Protocol of Insulin Dose Adjustment in a Low-Resource Setting

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 93-LB
Author(s):  
EDDY JEAN BAPTISTE ◽  
PHILIPPE LARCO ◽  
MARIE-NANCY CHARLES LARCO ◽  
JULIA E. VON OETTINGEN ◽  
EDDLYS DUBOIS ◽  
...  
Keyword(s):  
Dose Adjustment ◽  
Insulin Dose ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

scholarly journals Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting

2021 ◽  
Vol 14 (4) ◽  
pp. e239250
Author(s):  
Vijay Anand Ismavel ◽  
Moloti Kichu ◽  
David Paul Hechhula ◽  
Rebecca Yanadi
Keyword(s):  
Plastic Material ◽  
Successful Outcome ◽  
Paraduodenal Hernia ◽  
Transparent Plastic ◽  
Low Resource ◽  
Entire Small Bowel ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Right Paraduodenal Hernia ◽  
Bowel Gangrene

We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.

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