School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa.
School of Public Health / College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda.
BMC Pregnancy Childbirth. 2022 Jan 20;22(1):52. doi: 10.1186/s12884-022-04393-9.
Globally, mobile health (mHealth) applications are known for their potential to improve healthcare providers' access to relevant and reliable health information. Besides, electronic decision support tools, such as the Safe Delivery mHealth Application (SDA), may help to reduce clinical errors and to ensure quality care at the point of service delivery. The current study investigated the use of the SDA and its relationship to basic emergency obstetric and newborn care (BEmONC) outcomes for the most frequent complications in Rwanda; post-partum haemorrhage (PPH) and newborn asphyxia.
The study adopted a pre-post intervention design. A pre-intervention record review of BEmONC outcomes: Apgar score and PPH progressions, was conducted for 6 months' period (February 2019 - July 2019). The intervention took place in two district hospitals in Rwanda and entails the implementation of the SDA for 6 months (October 2019- March 2020), and included 54 nurses and midwives using the SDA to manage PPH and neonatal resuscitation. Six months' post-SDA intervention, the effect of the SDA on BEmONC outcomes was evaluated. The study included 327 participants (114 cases of PPH and 213 cases of neonatal complications). The analysis compared the outcome variables between the baseline and the endline data. Fisher's exact test was used to compare the proportions and test between-group differences and significance level set at p < 0.05.
Unstable newborn outcomes following neonatal resuscitation were recorded in 62% newborns cases at baseline and 28% newborns cases at endline, P-value = 0.000. Unstable maternal outcomes following PPH management were recorded in 19% maternal cases at baseline and 6% maternal cases at endline, P-value = 0.048. There was a significant association between the SDA intervention and newborns' and maternal' outcomes following neonatal resuscitation and PPH management, 6 months after baseline.
The use of the SDA supported nurses and midwives in the management of PPH and neonatal resuscitation which may have contributed to improved maternal and neonatal outcomes during 6 months of the SDA intervention. The findings of this study are promising as they contribute to a broader knowledge about the effectiveness of SDA in low and middle income hospital settings.
在全球范围内，移动医疗（mHealth）应用程序以其为医疗保健提供者提供相关和可靠健康信息的潜力而闻名。此外，电子决策支持工具，如安全分娩移动医疗应用程序（SDA），有助于减少临床错误，并确保在服务提供点提供高质量的护理。本研究调查了 SDA 的使用情况及其与卢旺达最常见并发症（产后出血[PPH]和新生儿窒息）的基本紧急产科和新生儿护理（BEmONC）结果之间的关系。
本研究采用了干预前后的设计。对 BEmONC 结果（阿普加评分和 PPH 进展）进行了 6 个月（2019 年 2 月至 2019 年 7 月）的干预前记录回顾。干预在卢旺达的两家地区医院进行，包括在 6 个月（2019 年 10 月至 2020 年 3 月）期间实施 SDA，并包括 54 名使用 SDA 管理 PPH 和新生儿复苏的护士和助产士。在 SDA 干预后 6 个月，评估了 SDA 对 BEmONC 结果的影响。该研究包括 327 名参与者（114 例 PPH 病例和 213 例新生儿并发症病例）。分析比较了基线数据和终线数据之间的结果变量。Fisher 确切检验用于比较比例和组间差异检验，显著性水平设为 p<0.05。
新生儿复苏后新生儿结局不稳定的情况，在基线时有 62%的新生儿病例，在终线时有 28%的新生儿病例，p 值=0.000。在 PPH 管理后，产妇结局不稳定的情况，在基线时有 19%的产妇病例，在终线时有 6%的产妇病例，p 值=0.048。在 SDA 干预后 6 个月，SDA 干预与新生儿复苏和 PPH 管理后的新生儿和产妇结局之间存在显著关联。
SDA 的使用支持护士和助产士管理 PPH 和新生儿复苏，这可能有助于改善 SDA 干预 6 个月期间产妇和新生儿的结局。本研究的结果很有希望，因为它们为 SDA 在中低收入医院环境中的有效性提供了更广泛的知识。
