scholarly journals Feasibility of a Mobile Health Tool for Mothers to Identify Neonatal Illness in Rural Uganda: Acceptability Study

10.2196/16426 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e16426
Author(s):  
Shababa B Matin ◽  
Allison Wallingford ◽  
Shicheng Xu ◽  
Natalie Ng ◽  
Anthony Ho ◽  
...  
Keyword(s):  
Health Workers ◽  
Health Assessment ◽  
Care Seeking ◽  
Wearable Sensor ◽  
Middle Income ◽  
Neonatal Deaths ◽  
Danger Signs ◽  
Study Team ◽  
And Training ◽  
At Home

Background A shortage of community health workers to triage sick neonates and poor recognition of neonatal illness by mothers contribute significantly toward neonatal deaths in low- and middle-income countries. Providing low-resource communities with the tools and knowledge to recognize signs of neonatal distress can lead to early care-seeking behavior. To empower and educate mothers to recognize signs of neonatal illness, we developed a neonatal health assessment device consisting of a smartphone app and a wearable sensor (the NeMo system). Objective The aim of this study was to determine if mothers in rural Uganda were willing and able to use the NeMo system during the first week of their infant’s life. We also assessed mothers’ responses to the device’s recommendation to seek care. Methods A total of 20 mothers were enrolled in the study after giving birth in the Iganga District Hospital. Each mother was trained to use the NeMo system to assess her infant for signs of illness before leaving the hospital and was given the NeMo system to use at home for 1 week. Throughout the week, the smartphone tracked the mothers’ usage of NeMo, and the study team visited twice to observe mothers’ ability to use NeMo. Each mother was interviewed at the end of 1 week to gather qualitative feedback on her experience with the NeMo system. Results In total, 18 mothers completed the study; 2 mothers were withdrawn during the week because of extenuating health circumstances. Moreover, 1 day after enrollment and training, 75% (15/20) of mothers used NeMo properly with no mistakes. 3 days after enrollment and training, only 1 mother placed the wearable sensor improperly on her infant. On the final study day, only 1 mother connected the device improperly. Mothers used NeMo an average of 11.67 (SD 5.70) times on their own at home during the 5 full study days. Although the frequency of use per day decreased from day 1 to day 5 of the study (P=.04), 72% (13/18) of mothers used NeMo at least once per day. In total, 64% (9/14) of mothers who received an alert from the NeMo system to seek care for their infants either called the health care professional working with the study team or reused the system immediately and found no danger signs. All 18 mothers agreed or strongly agreed that the NeMo system was easy to use and helped them know when to seek care for their babies. Conclusions NeMo is a feasible and acceptable tool to aid mothers in rural Uganda to assess their infant’s health.

scholarly journals Scoping review assessing the evidence used to support the adoption of mobile health (mHealth) technologies for the education and training of community health workers (CHWs) in low-income and middle-income countries

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e019827 ◽  
Author(s):  
Niall Winters ◽  
Laurenz Langer ◽  
Anne Geniets
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Low Income ◽  
Health Workers ◽  
Education And Training ◽  
Evidence Base ◽  
Mobile Technologies ◽  
Middle Income ◽  
And Training ◽  
Formal Theories

ObjectivesUndertake a systematic scoping review to determine how a research evidence base, in the form of existing systematic reviews in the field of mobile health (mHealth), constitutes education and training for community health workers (CHWs) who use mobile technologies in everyday work. The review was informed by the following research questions: does educational theory inform the design of the education and training component of mHealth interventions? How is education and training with mobile technology by CHWs in low-income and middle-income countries categorised by existing systematic reviews? What is the basis for this categorisation?SettingThe review explored the literature from 2000 to 2017 to investigate how mHealth interventions have been positioned within the available evidence base in relation to their use of formal theories of learning.ResultsThe scoping review found 24 primary studies that were categorised by 16 systematic reviews as supporting CHWs’ education and training using mobile technologies. However, when formal theories of learning from educational research were used to recategorise these 24 primary studies, only four could be coded as such. This identifies a problem with how CHWs’ education and training using mobile technologies is understood and categorised within the existing evidence base. This is because there is no agreed on, theoretically informed understanding of what counts as learning.ConclusionThe claims made by mHealth researchers and practitioners regarding the learning benefits of mobile technology are not based on research results that are underpinned by formal theories of learning. mHealth suffers from a reductionist view of learning that underestimates the complexities of the relationship between pedagogy and technology. This has resulted in miscategorisations of what constitutes CHWs’ education and training within the existing evidence base. This can be overcome by informed collaboration between the health and education communities.

scholarly journals Neonatal Deaths in Rural Southern Tanzania: Care-Seeking and Causes of Death

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Mwifadhi Mrisho ◽  
David Schellenberg ◽  
Fatuma Manzi ◽  
Marcel Tanner ◽  
Hassan Mshinda ◽  
...  
Keyword(s):  
Verbal Autopsy ◽  
Birth Asphyxia ◽  
Household Survey ◽  
Care Seeking ◽  
Neonatal Deaths ◽  
Rural Districts ◽  
Common Causes ◽  
Large Household ◽  
Quantitative Results ◽  
At Home

Introduction. We report cause of death and care-seeking prior to death in neonates based on interviews with relatives using a Verbal Autopsy questionnaire. Materials and Methods. We identified neonatal deaths between 2004 and 2007 through a large household survey in 2007 in five rural districts of southern Tanzania. Results. Of the 300 reported deaths that were sampled, the Verbal Autopsy (VA) interview suggested that 11 were 28 days or older at death and 65 were stillbirths. Data was missing for 5 of the reported deaths. Of the remaining 219 confirmed neonatal deaths, the most common causes were prematurity (33%), birth asphyxia (22%) and infections (10%). Amongst the deaths, 41% (90/219) were on the first day and a further 20% (43/219) on day 2 and 3. The quantitative results matched the qualitative findings. The majority of births were at home and attended by unskilled assistants. Conclusion. Caregivers of neonates born in health facility were more likely to seek care for problems than caregivers of neonates born at home. Efforts to increase awareness of the importance of early care-seeking for a premature or sick neonate are likely to be important for improving neonatal health.

scholarly journals The multifaceted care-seeking practices among caregivers of children with cerebral palsy: Perspectives from mothers and providers in Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258650
Author(s):  
Victoria Fonzi ◽  
Blessed Sheriff ◽  
Sarah Dalglish ◽  
Adote Anum ◽  
Emmanuella Dwomo Agyei ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Low Cost ◽  
Treatment Options ◽  
Home Treatment ◽  
Alternative Methods ◽  
Care Seeking ◽  
Medical Providers ◽  
Structured Interviews ◽  
Middle Income ◽  
At Home

Background Research on cerebral palsy (CP) has lacked emphasis on knowledge and treatment practices among caregivers, particularly in low- and middle-income countries where socio-cultural contexts encourage a variety of treatment alternatives. In this study, we explored the beliefs and experiences that motivate care-seeking practices among caregivers of children with CP in Ghana. Methods Semi-structured interviews were conducted with 25 caregivers, 10 medical providers, and 5 alternative providers in the Greater Accra Region. Participant interviews were analyzed using principles adapted from grounded theory. A conceptual model was constructed to illustrate salient patterns and motivational factors influencing care-seeking practices. Results Participants’ experiences showed that caregivers initially sought physiotherapy and prescription medications from medical providers. Many of them then transitioned to alternative methods to search for a cure or address specific CP symptoms. Over time, most caregivers discontinued both medical and alternative care in favor of at-home treatment. A few withdrew completely from all forms of care. Cost of treatment, caregiver burden, and stigma strongly inhibited care-seeking outside the home. Conclusion Although caregivers were open to exploring a variety of treatment options, at-home treatment was preferred by long-time caregivers for its convenience, low cost, and adaptability to patient and caregiver needs.

scholarly journals Verbal autopsy of neonatal deaths in Khatauli Block of District Muzaffarnagar, Uttar Pradesh, India

2014 ◽  
Vol 4 (5) ◽  
pp. 423-427
Author(s):  
K Muzammil ◽  
JV Singh ◽  
R Shankar
Keyword(s):  
Verbal Autopsy ◽  
Rural Areas ◽  
Neonatal Jaundice ◽  
Health Workers ◽  
Uttar Pradesh ◽  
Cross Sectional ◽  
Neonatal Deaths ◽  
Medical Certification ◽  
Cause Of Deaths ◽  
At Home

BackgroundVerbal autopsy is a method of inquiry to ascertain the likely cause of death in populations where vital registration of deaths is incomplete and unreliable. Over 75% of deaths in India occur at homes; more than half of these do not have a certified cause. Further, most of the deaths in the rural areas of India occur at home and that is why a medical certification by a qualified practitioner is not possible. Keeping these facts in mind, this study was designed having objectives as to find out the causes of neonatal deaths through verbal autopsy and its feasibility to be used by health workers.Material & Methods:This cross-sectional epidemiological study was conducted in randomly selected rural areas of Khatauli Block of District Muzaffarnagar, Uttar Pradesh, India. Verbal autopsy data was collected by a team of health workers adequately trained for the same well in advance. Data related to reported neonatal deaths in the study area in the specified period of time was collected on structured & pre-tested questionnaire used as study tool by interviewing the parents, relatives or neighbours of the deceased. Data thus collected was verified twice by the coordinator and principal investigator respectively and analyzed by using Epi info statistical package.Results:A total of 24 perinatal deaths were reported, out of which 7 (29.2%) were stillbirth and 17 (70.8%) were neonatal deaths. ANC was received by 14 mothers (58.3%). Half of the deliveries were conducted by untrained Dai. About 20 deliveries (83.3%) were at home and 10 (58.8%) of the deceased were early neonates. The cause of deaths found by means of verbal autopsies were mainly: pneumonia - 4 (23.5%), diarrhoea - 2 (11.8%) neonatal jaundice - 03 (17.6%) etc.Conclusion:Pneumonia, diarrhoea & neonatal jaundice alone constitute about 53% of the total neonatal deaths. The use of the verbal autopsy tool by health workers to find out the cause of neonatal deaths is very much feasible.DOI: http://dx.doi.org/10.3126/nje.v4i5.12019 Nepal Journal of Epidemiology 2014; 4(5):423-27

scholarly journals Training programs to improve identification of sick newborns and care-seeking from a health facility in low- and middle-income countries: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alastair Fung ◽  
Elisabeth Hamilton ◽  
Elsabé Du Plessis ◽  
Nicole Askin ◽  
Lisa Avery ◽  
...  
Keyword(s):  
Health Facility ◽  
Scoping Review ◽  
Training Programs ◽  
Health Workers ◽  
Newborn Care ◽  
Care Seeking ◽  
Care Providers ◽  
Inclusion Criteria ◽  
Middle Income ◽  
Care Training

Abstract Background Most neonatal deaths occur in low- and middle-income countries (LMICs). Limited recommendations are available on the optimal personnel and training required to improve identification of sick newborns and care-seeking from a health facility. We conducted a scoping review to map the key components required to design an effective newborn care training program for community-based health workers (CBHWs) to improve identification of sick newborns and care-seeking from a health facility in LMICs. Methods We searched multiple databases from 1990 to March 2020. Employing iterative scoping review methodology, we narrowed our inclusion criteria as we became more familiar with the evidence base. We initially included any manuscripts that captured the concepts of “postnatal care providers,” “neonates” and “LMICs.” We subsequently included articles that investigated the effectiveness of newborn care provision by CBHWs, defined as non-professional paid or volunteer health workers based in communities, and their training programs in improving identification of newborns with serious illness and care-seeking from a health facility in LMICs. Results Of 11,647 articles identified, 635 met initial inclusion criteria. Among these initial results, 35 studies met the revised inclusion criteria. Studies represented 11 different types of newborn care providers in 11 countries. The most commonly studied providers were community health workers. Key outcomes to be measured when designing a training program and intervention to increase appropriate assessment of sick newborns at a health facility include high newborn care provider and caregiver knowledge of newborn danger signs, accurate provider and caregiver identification of sick newborns and appropriate care-seeking from a health facility either through caregiver referral compliance or caregivers seeking care themselves. Key components to consider to achieve these outcomes include facilitators: sufficient duration of training, refresher training, supervision and community engagement; barriers: context-specific perceptions of newborn illness and gender roles that may deter care-seeking; and components with unclear benefit: qualifications prior to training and incentives and remuneration. Conclusion Evidence regarding key components and outcomes of newborn care training programs to improve CBHW identification of sick newborns and care-seeking can inform future newborn care training design in LMICs. These training components must be adapted to country-specific contexts.

scholarly journals Preparing to launch the ‘Thinking Healthy Programme’ perinatal depression intervention in Urban Lima, Peru: experiences from the field

2018 ◽  
Vol 5 ◽  
Author(s):  
B. S. Eappen ◽  
M. Aguilar ◽  
K. Ramos ◽  
C. Contreras ◽  
M. C. Prom ◽  
...  
Keyword(s):  
Perinatal Depression ◽  
Health Workers ◽  
World Health ◽  
Depression Care ◽  
Middle Income ◽  
Intervention Delivery ◽  
Implementation Team ◽  
Perinatal Women ◽  
And Training ◽  
Depression Intervention

Background.An estimated 19–25% of perinatal women in low- and middle-income countries are affected by depression which, untreated, is associated with multiple health problems for mothers and children. Nonetheless, few perinatal women have access to depression care. The Thinking Healthy Programme (THP), promoted by the World Health Organization (WHO), is an evidence-based, non-specialist delivered depression intervention that addresses this care gap. However, the WHO THP manual explains intervention delivery but not the antecedents to implementation. Here, we describe a principled, planned approach leading to the implementation of THP in Lima, Peru by the non-profit organization Socios En Salud with community health workers (CHW) to inform its implementation in other settings.Methods.The Replicating Effective Programs (REP) framework guided THP implementation, following four phases: (I) pre-conditions; (II) pre-implementation; (III) implementation; and (IV) maintenance and evolution. This paper centers on REP phases I and II, including (1) documented high perinatal depression rates in Peru; (2) designation of perinatal depression as a government priority; (3) THP Implementation Team orientation and training; (4) data collection plan development; (5) public health system coordination; (6) CHW selection and training; and (7) THP launch.Results.Between December 2016 and March 2017, a THP training program was developed and seven CHW were trained to deliver the intervention to 10 perinatal women, the first of whom was enrolled on 17 April 2017.Conclusions.THP was rapidly implemented by a community-based organization with no prior experience in delivering non-specialist perinatal depression care. The steps followed may inform the implementation of THP in other settings.

scholarly journals Approaches to motivate physicians and nurses in low- and middle-income countries: a systematic literature review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jaya Gupta ◽  
Mariya C. Patwa ◽  
Angel Khuu ◽  
Andreea A. Creanga
Keyword(s):  
Systematic Review ◽  
Randomized Trial ◽  
Health Worker ◽  
Work Motivation ◽  
Health Workers ◽  
Trial Group ◽  
Middle Income ◽  
Group Design ◽  
Middle Income Countries ◽  
Worker Motivation

AbstractPoor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial—group design, one used a non-randomized trial—group design, one used a cross-sectional design, and one used a pretest–posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.

scholarly journals Diagnosis of gestational diabetes in Uganda: The reactions of women, family members and health workers

2021 ◽  
Vol 17 ◽  
pp. 174550652110137
Author(s):  
Flavia Zalwango ◽  
Janet Seeley ◽  
Arthur Namara ◽  
Sanjay Kinra ◽  
Moffat Nyirenda ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health Workers ◽  
Family Members ◽  
Medical Attention ◽  
Middle Income ◽  
Diabetes Mellitus Diagnosis ◽  
Life Threatening ◽  
Fear And Anxiety

Objectives: In Uganda, as in many other low- and middle-income countries, screening for gestational diabetes mellitus is suboptimal and is rarely embedded in routine antenatal care. We describe the experiences of women in Uganda who underwent screening for gestational diabetes mellitus and were diagnosed with the condition as they navigate both the reaction of family members and their interaction with health workers. Methods: Pregnant women aged 18 years or older and between 24 and 28 weeks of gestation were enrolled from the antenatal clinics at one of the five hospitals between 13 June 2018 and 31 October 2019. Ten women with gestational diabetes mellitus, ten family members and six health workers were purposively selected to take part. Interviews and focus group discussions were used to collect data on the socio-cultural and health system factors that influence timely screening and effective management of gestational diabetes mellitus in Uganda. Data were analysed thematically. Results: Women generally reflected on the importance of gestational diabetes mellitus screening and felt that an early diagnosis helped them to get timely medical attention, and most reported a positive experience of the care provided by health workers. However, women who were diagnosed with gestational diabetes mellitus reported feeling fearful and anxious, and some were worried that the condition might be life-threatening. Many women reported that they were upset and largely unprepared to receive a gestational diabetes mellitus diagnosis. A gestational diabetes mellitus diagnosis not only stirred intense feelings of fear and anxiety in women but also affected their spouses and other family members. Many male partners were sympathetic and willing to provide support. Conclusion: Our findings highlight the need to understand the perceptions and emotions that accompany a gestational diabetes mellitus diagnosis to best support women and their family members. An improved recognition of these factors can inform the development of effective gestational diabetes mellitus screening and management programmes.

scholarly journals Context matters in understanding the vulnerability of women: perspectives from southwestern Uganda

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Neema Murembe ◽  
Teddy Kyomuhangi ◽  
Kimberly Manalili ◽  
Florence Beinempaka ◽  
Primrose Nakazibwe ◽  
...  
Keyword(s):  
Health Workers ◽  
Geographical Location ◽  
Middle Income ◽  
Extreme Poverty ◽  
Economic Class ◽  
Individual Interviews ◽  
Resource Limited ◽  
The People ◽  
The Individual ◽  
Southwestern Uganda

Abstract Background Vulnerability at the individual, family, community or organization level affects access and utilization of health services, and is a key consideration for health equity. Several frameworks have been used to explore the concept of vulnerability and identified demographics including ethnicity, economic class, level of education, and geographical location. While the magnitude of vulnerable populations is not clearly documented and understood, specific indicators, such as extreme poverty, show that vulnerability among women is pervasive. Women in low and middle-income countries often do not control economic resources and are culturally disadvantaged, which exacerbates other vulnerabilities they experience. In this commentary, we explore the different understandings of vulnerability and the importance of engaging communities in defining vulnerability for research, as well as for programming and provision of maternal newborn and child health (MNCH) services. Methodology In a recent community-based qualitative study, we examined the healthcare utilization experiences of vulnerable women with MNCH services in rural southwestern Uganda. Focus group discussions were conducted with community leaders and community health workers in two districts of Southwestern Uganda. In addition, we did individual interviews with women living in extreme poverty and having other conventional vulnerability characteristics. Findings and discussion We found that the traditional criteria of vulnerability were insufficient to identify categories of vulnerable women to target in the context of MNCH programming and service provision in resource-limited settings. Through our engagement with communities and through the narratives of the people we interviewed, we obtained insight into how nuanced vulnerability can be, and how important it is to ground definitions of vulnerability within the specific context. We identified additional aspects of vulnerability through this study, including: women who suffer from alcoholism or have husbands with alcoholism, women with a history of home births, women that have given birth only to girls, and those living on fishing sites. Conclusion Engaging communities in defining vulnerability is critical for the effective design, implementation and monitoring of MNCH programs, as it ensures these services are reaching those who are most in need.

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