scholarly journals Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App and Dashboard: A 1-Year Digital Perinatal Outcome Audit

2021 ◽  
Vol 3 ◽  
Author(s):  
Yamikani Mgusha ◽  
Deliwe Bernadette Nkhoma ◽  
Msandeni Chiume ◽  
Beatrice Gundo ◽  
Rodwell Gundo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Case Fatality ◽  
Mobile App ◽  
Data Capture ◽  
Neonatal Unit ◽  
Sub Saharan Africa ◽  
Digital Data ◽  
Low Resource ◽  
Modifiable Factors ◽  
The Impact

Introduction: Understanding the extent and cause of high neonatal deaths rates in Sub-Saharan Africa is a challenge, especially in the presence of poor-quality and inaccurate data. The NeoTree digital data capture and quality improvement system has been live at Kamuzu Central Hospital, Neonatal Unit, Malawi, since April 2019.Objective: To describe patterns of admissions and outcomes in babies admitted to a Malawian neonatal unit over a 1-year period via a prototype data dashboard.Methods: Data were collected prospectively at the point of care, using the NeoTree app, which includes digital admission and outcome forms containing embedded clinical decision and management support and education in newborn care according to evidence-based guidelines. Data were exported and visualised using Microsoft Power BI. Descriptive and inferential analysis statistics were executed using R.Results: Data collected via NeoTree were 100% for all mandatory fields and, on average, 96% complete across all fields. Coverage of admissions, discharges, and deaths was 97, 99, and 91%, respectively, when compared with the ward logbook. A total of 2,732 neonates were admitted and 2,413 (88.3%) had an electronic outcome recorded: 1,899 (78.7%) were discharged alive, 12 (0.5%) were referred to another hospital, 10 (0.4%) absconded, and 492 (20%) babies died. The overall case fatality rate (CFR) was 204/1,000 admissions. Babies who were premature, low birth weight, out born, or hypothermic on admission, and had significantly higher CFR. Lead causes of death were prematurity with respiratory distress (n = 252, 51%), neonatal sepsis (n = 116, 23%), and neonatal encephalopathy (n = 80, 16%). The most common perceived modifiable factors in death were inadequate monitoring of vital signs and suboptimal management of sepsis. Two hundred and two (8.1%) neonates were HIV exposed, of whom a third [59 (29.2%)] did not receive prophylactic nevirapine, hence vulnerable to vertical infection.Conclusion: A digital data capture and quality improvement system was successfully deployed in a low resource neonatal unit with high (1 in 5) mortality rates providing and visualising reliable, timely, and complete data describing patterns, risk factors, and modifiable causes of newborn mortality. Key targets for quality improvement were identified. Future research will explore the impact of the NeoTree on quality of care and newborn survival.

scholarly journals Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App: Digital Perinatal Outcome Audit (Preprint)

2019 ◽  
Author(s):  
Caroline Crehan ◽  
Erin Kesler ◽  
Indira Angela Chikomoni ◽  
Kristi Sun ◽  
Queen Dube ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Case Fatality ◽  
Mobile App ◽  
Proof Of Concept ◽  
Discharge Data ◽  
Low Resource ◽  
Modifiable Factors

BACKGROUND Mobile health (mHealth) is showing increasing potential to address health outcomes in underresourced settings as smartphone coverage increases. The NeoTree is an mHealth app codeveloped in Malawi to improve the quality of newborn care at the point of admission to neonatal units. When collecting vital demographic and clinical data, this interactive platform provides clinical decision support and training for the end users (health care professionals [HCPs]), according to evidence-based national and international guidelines. OBJECTIVE This study aims to examine 1 month’s data collected using NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital outcome audit data in this setting. METHODS Using a phased approach over 1 month (November 21-December 19, 2016), frontline HCPs were trained and supported to use NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within NeoTree, called <i>NeoDischarge</i>. We conducted a descriptive analysis of the exported pseudoanonymized data and presented it to the newborn care department as a digital outcome audit. RESULTS Of 191 total admissions, 134 (70.2%) admissions were completed using NeoTree, and 129 (67.5%) were exported and analyzed. Of 121 patients for whom outcome data were available, 102 (84.3%) were discharged alive. The overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, birth asphyxia, and neonatal sepsis contributed to 25% (3/12), 58% (7/12), and 8% (1/12) of deaths, respectively. Data were more than 90% complete for all fields. Deaths may have been underreported because of phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterization of the data enabled departmental discussion of modifiable factors for quality improvement, for example, improved thermoregulation of infants. CONCLUSIONS This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCPs in underresourced newborn facilities, and these data can contribute to a meaningful review of the quality of care, outcomes, and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audits in low-resource settings and are a proof of concept for a novel newborn data system in these settings.

scholarly journals Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App: Digital Perinatal Outcome Audit

10.2196/16485 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e16485
Author(s):  
Caroline Crehan ◽  
Erin Kesler ◽  
Indira Angela Chikomoni ◽  
Kristi Sun ◽  
Queen Dube ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Case Fatality ◽  
Mobile App ◽  
Proof Of Concept ◽  
Discharge Data ◽  
Low Resource ◽  
Modifiable Factors

Background Mobile health (mHealth) is showing increasing potential to address health outcomes in underresourced settings as smartphone coverage increases. The NeoTree is an mHealth app codeveloped in Malawi to improve the quality of newborn care at the point of admission to neonatal units. When collecting vital demographic and clinical data, this interactive platform provides clinical decision support and training for the end users (health care professionals [HCPs]), according to evidence-based national and international guidelines. Objective This study aims to examine 1 month’s data collected using NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital outcome audit data in this setting. Methods Using a phased approach over 1 month (November 21-December 19, 2016), frontline HCPs were trained and supported to use NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within NeoTree, called NeoDischarge. We conducted a descriptive analysis of the exported pseudoanonymized data and presented it to the newborn care department as a digital outcome audit. Results Of 191 total admissions, 134 (70.2%) admissions were completed using NeoTree, and 129 (67.5%) were exported and analyzed. Of 121 patients for whom outcome data were available, 102 (84.3%) were discharged alive. The overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, birth asphyxia, and neonatal sepsis contributed to 25% (3/12), 58% (7/12), and 8% (1/12) of deaths, respectively. Data were more than 90% complete for all fields. Deaths may have been underreported because of phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterization of the data enabled departmental discussion of modifiable factors for quality improvement, for example, improved thermoregulation of infants. Conclusions This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCPs in underresourced newborn facilities, and these data can contribute to a meaningful review of the quality of care, outcomes, and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audits in low-resource settings and are a proof of concept for a novel newborn data system in these settings.

scholarly journals Mobile App to Improve House Officers’ Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study

10.2196/15762 ◽  
2020 ◽  
Vol 8 (5) ◽  
pp. e15762
Author(s):  
Vittal Hejjaji ◽  
Ali O Malik ◽  
Poghni A Peri-Okonny ◽  
Merrill Thomas ◽  
Yuanyuan Tang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Quality Improvement ◽  
Chest Compression ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Mobile App ◽  
Absolute Difference ◽  
Quality Improvement Initiative ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers’ adherence to ACLS guidelines. Methods As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference –0.7 [95% CI –0.3 to –1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9% vs 89.0%; absolute difference 1.9% [95% CI 0.6% to 3.4%]; P=.007). Conclusions This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown.

scholarly journals Mobile App to Improve House Officers’ Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study (Preprint)

2019 ◽  
Author(s):  
Vittal Hejjaji ◽  
Ali O Malik ◽  
Poghni A Peri-Okonny ◽  
Merrill Thomas ◽  
Yuanyuan Tang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Quality Improvement ◽  
Chest Compression ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Mobile App ◽  
Absolute Difference ◽  
Quality Improvement Initiative ◽  
The Impact ◽  
Hospital Cardiac Arrest

BACKGROUND Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. OBJECTIVE The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers’ adherence to ACLS guidelines. METHODS As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired <i>t</i> tests compared performance with and without the mobile app. RESULTS Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; <i>P</i>&lt;.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference –0.7 [95% CI –0.3 to –1.0]; <i>P</i>&lt;.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9% vs 89.0%; absolute difference 1.9% [95% CI 0.6% to 3.4%]; <i>P</i>=.007). CONCLUSIONS This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown.

scholarly journals Perinatal morbidity and mortality and the impact of neonatal resuscitation day-by-day calamity evidenced by a prospective descriptive study in Guinea-Conakry

2020 ◽  
Author(s):  
Abdourahamane DIALLO ◽  
Ibrahima Sory DIALLO ◽  
Ibrahima Koussy BAH ◽  
Mamadou Cellou DIALLO ◽  
David DESSEAUVE ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Transport System ◽  
Neonatal Unit ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
University Hospital ◽  
Perinatal Morbidity ◽  
Increased Risk ◽  
The University ◽  
The Impact

Abstract Background Perinatal mortality represents a major health care problem in particular in low and middle-income countries, which account for 97% of all late fetal and 98% of all neonatal deaths. Our objectif was to analyse perinatal morbidity and mortality at the largest maternity clinic of Guinea, in sub-Saharan Africa. Patients & Methods: Prospective observational evaluation of the perinatal morbidity and mortality between May 1st and June 30th 2019 at the Clinic of Obstetrics of the University Hospital Ignace Deen in Conakry, Guinea. Results Of the 1189 deliveries, 98 (82‰) fetus were born dead, 58.1% of them with signs of maceration. 14.1% of all infants had low birth weight (< 2500 g) and 10.6% were macrosome (> 4000 g). The rate of preterm infants was 9.3% and 99 infants (8.3%) showed signs of post-maturity. At birth, 6.8% of all live born infants had asphyxia, 10.9% respiratory distress, 1.9% infection, 0.3% malformation, and nine infants died within the first postnatal minutes. Need for any resuscitation manoeuvres showed 304 infants (27.9%), 68.8% of them needed bag and mask ventilation and 27.0% chest compressions. Infants with bad Apgar score at 1 and 5 minutes did improve by 10 minutes thanks to respiratory support, but not due to chest compression. As there is no neonatal unit in the same hospital, 192 infants (17.6%) had to be transferred across Conakry to the only tertiary neonatal unit. Due to lack of any (para-)medical transport system for newborn infants, mortality of these neonates is very high and adds to the total perinatal mortality of 143.8 deaths/1000 deliveries. Conclusions Late pregnancy control is very poor in Conakry, leading to delayed referral of high-risk pregnancies to the university hospital. This goes along with high rates of stillbirths, post-term and macrosome infants with increased risk for delivery complications like postnatal adaptation problems and asphyxia. Resuscitation algorithm needs to be adapted to the local context. A hospital-based neonatal unit for primary stabilization and a medicalised neonatal transport system within Conakry needs to be implemented to decrease the high mortality rate.

scholarly journals 1502 Admissions to a low-resource neonatal unit in Malawi using a mobile app and dashboard: a one year digital perinatal outcome audit

2021 ◽  
Author(s):  
Caroline Crehan ◽  
Yamikani Mgusha ◽  
Deliwe Bernadette Nkhoma ◽  
Msandeni Chiume-Kayuni ◽  
Beatrice Gundo ◽  
...  
Keyword(s):  
Perinatal Outcome ◽  
Mobile App ◽  
Neonatal Unit ◽  
Low Resource ◽  
One Year

scholarly journals Trends in Ultrasound Use in Low and Middle Income Countries: A Systematic Review

2020 ◽  
Vol 9 (1) ◽  
pp. 103-120
Author(s):  
Kelsey A. Stewart ◽  
Sergio M. Navarro ◽  
Sriharsha Kambala ◽  
Gail Tan ◽  
Revanth Poondla ◽  
...  
Keyword(s):  
Systematic Review ◽  
Global Health ◽  
Randomized Clinical Trials ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Low Resource ◽  
Middle Income Countries ◽  
Recent Trends ◽  
The Impact ◽  
Low And Middle Income

Background: Evidence on recent trends regarding the impact and cost-benefits of ultrasound in resource-constrained settings is limited. This study presents a systematic review to determine recent trends in the utility and applicability of ultrasound use in low and middle income countries (LMIC). The review includes characterizing and evaluating trends in (1) the geographic and specialty specific use of ultrasound in LMICs, (2) the innovative applications and the accompanying research findings, and (3) the development of associated educational and training programs. Methods: The electronic databases Medline OVID, EMBASE, and Cochrane were searched from 2010 to 2018 for studies available in English, French, and Spanish. Commentaries, opinion articles, reviews and book chapters were excluded. Two categories were created, one for reported applications of ultrasound use in LMICs and another for novel ultrasound studies. Results: A total of 6,276 articles were identified and screened, 4,563 studies were included for final review. 287 studies contained original or novel applications of ultrasound use in LMICs. Nearly 70% of studies involved ultrasound usage originating from Southeast Asia and sub-Saharan Africa, the latter being the region with the highest number of innovative ultrasound use. Educational studies, global collaborations, and funded studies were a substantial subset of overall ultrasound research. Our findings are limited by the lack of higher quality evidence and limited number of randomized clinical trials reported. Conclusion/Global Health Implications: Our systematic literature review of ultrasound use in LMICs demonstrates the growing utilization of this relatively low-cost, portable imaging technology in low resource settings. Key words: • Ultrasound • Ultrasono graph y • Echocardiogram • LMIC • Low resource • Global health • Systematic review   Copyright © 2020 Stewart et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Conflicts in Biafra, Katanga and Cabinda as a result of the geopolitical legacy of colonialism

2020 ◽  
Vol 2020 (10-3) ◽  
pp. 238-246
Author(s):  
Olga Dzhenchakova
Keyword(s):  
Democratic Republic ◽  
Economic Factor ◽  
Colonial Period ◽  
Sub Saharan Africa ◽  
Negative Consequences ◽  
Post Colonial ◽  
Republic Of The Congo ◽  
Sub Saharan ◽  
The Republic ◽  
The Impact

The article considers the impact of the colonial past of some countries in sub-Saharan Africa and its effect on their development during the post-colonial period. The negative consequences of the geopolitical legacy of colonialism are shown on the example of three countries: Nigeria, the Democratic Republic of the Congo and the Republic of Angola, expressed in the emergence of conflicts in these countries based on ethno-cultural, religious and socio-economic contradictions. At the same time, the focus is made on the economic factor and the consequences of the consumer policy of the former metropolises pursuing their mercantile interests were mixed.

The Institute for Healthcare Improvement–NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols

2020 ◽  
Vol 33 (6) ◽  
pp. 812-821
Author(s):  
Scott L. Zuckerman ◽  
Clinton J. Devin ◽  
Vincent Rossi ◽  
Silky Chotai ◽  
E. Hunter Dyer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Discharge Planning ◽  
Lumbar Fusion ◽  
Nonparametric Tests ◽  
Learning System ◽  
Design Quality ◽  
Implementation Phase ◽  
Healthcare Improvement ◽  
The Impact

OBJECTIVENational databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module.METHODSThe NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention.RESULTSThe novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0–10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342).CONCLUSIONSThe NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.

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