Amoakoh Hannah Brown, Klipstein-Grobusch Kerstin, Agyepong Irene Akua, Amoakoh-Coleman Mary, Kayode Gbenga A, Reitsma J B, Grobbee Diederick E, Ansah Evelyn K
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, The Netherlands.
School of Public Health, University of Ghana, P.O. Box LG13, Legon, Accra, Ghana.
BMC Pediatr. 2020 Nov 27;20(1):534. doi: 10.1186/s12887-020-02378-1.
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.
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.
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.
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.
本研究评估了在实施移动健康（mHealth）临床决策支持系统（mCDMSS）之前及期间，卫生工作者对新生儿健康协议的遵守情况。该系统旨在弥补资源匮乏地区在获取新生儿健康协议方面的差距。
我们在两个有目的选择的群组（一个资源匮乏，一个资源丰富）中进行了横断面文件审查，这两个群组来自一项整群随机试验的每个组，审查时间为两个不同时间点：试验前和试验期间。整个试验包括16个群组，随机分为8个干预组和8个对照组，以评估mCDMSS对加纳新生儿死亡率的影响。我们通过使用检查表审查新生儿住院患者的病历，评估卫生工作者对出生窒息、新生儿黄疸和脐带败血症协议的遵守情况（以百分比表示）。使用Wilcoxon秩和检验和置换检验评估各发病类型在研究组内和组间对新生儿健康协议遵守情况的差异。此外，我们在18个月的干预期内跟踪了各群组中同时开展的新生儿健康改善活动。
在干预组中，窒息协议的平均遵守率在干预前和干预期间分别为35.2%（标准差=5.8%）和43.6%（标准差=27.5%）；黄疸协议的平均遵守率分别为25.0%（标准差=14.8%）和39.3%（标准差=27.7%）；脐带败血症协议的平均遵守率分别为52.0%（标准差=11.0%）和75.0%（标准差=21.2%）。在对照组中，窒息协议的平均遵守率在干预前和干预期间分别为52.9%（标准差=16.4%）和74.5%（标准差=14.7%）；黄疸协议的平均遵守率分别为45.1%（标准差=12.8%）和64.6%（标准差=8.2%）；脐带败血症协议的平均遵守率分别为53.8%（标准差=1
