mHealth technology supporting community health worker-led surgical site infection diagnosis after cesarean section in rural Rwanda: A randomized control trial (Preprint)

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 has 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 post-operative care for women after c-section, such as SSI checks. OBJECTIVE This trial assessed whether CHW/mobile health (mHealth) interventions improved rates of return to care among women developing an SSI following c-section at a rural Rwandan district hospital. METHODS 1,025 women aged ≥18 years who underwent a c-section between November 2017 and September 2018 at Kirehe District Hospital were randomized into three post-operative arms: 1) home visit, 2) phone call, and 3) routine health center follow-up. A CHW-led, mHealth-supported SSI diagnostic protocol was delivered in intervention arms. We assessed intervention completion in each intervention arm and used logistic regression to assess impact on return to care. RESULTS We randomized 335 women to Arm 1, 334 to Arm 2, and 356 to Arm 3. 88.1% of women in Arm 1 and 68.3% in Arm 2 were successfully assessed for an SSI. There were high rates of returning to clinic within 30-days across arms (Arm 1: 99.7%, Arm 2: 98.4%, Arm 3: 99.7%; P=.209). CONCLUSIONS Home-based post-c-section follow-up is feasible in rural Africa when performed by mHealth-supported CHWs. There was no difference in return to care rates but given the significant expense of traveling to a health center, this intervention could create substantial benefit. CLINICALTRIAL ClinicalTrials.gov NCT03311399