Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 2, 2021
Open Peer Review Period: Dec 2, 2021 - Jan 27, 2022
Date Accepted: May 4, 2022
(closed for review but you can still tweet)
The effect and feasibility of mHealth-supported surgical site infection diagnosis by community health workers after cesarean section in rural Rwanda: A randomized-controlled trial
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 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. Clinical Trial: ClinicalTrials.gov NCT03311399
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