乌干达农村地区医院至家庭出院及随访项目的可行性、可接受性和初步效果：一项混合方法干预研究

Feasibility, acceptability and preliminary effectiveness of the Hospital to Home discharge and follow-up programme in rural Uganda: a mixed-methods intervention study.

作者信息

Niyonshaba Beatrice, Kabugo Daniel, Nakiganda Cornety, Otai Christine, Seela Margret, Nankabala Joyce, Nyonyintono James, Nakakande Josephine, Kigozi Tadeo, Vaughan Madeline, Nakamura Heidi, Paudel Mohan, Haddix-McKay Kimber, Al-Haddad Benjamin J S, Tann Cally J, Mubiri Paul, Waiswa Peter, Magnusson Brooke

机构信息

Adara Development Uganda, Luwero, Nakaseke District, Uganda.

Mulago Specialised Hospital, Kampala, Uganda.

出版信息

BMJ Glob Health. 2025 Feb 12;10(2):e015945. doi: 10.1136/bmjgh-2024-015945.

DOI:10.1136/bmjgh-2024-015945

PMID:39939110

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11822387/

Abstract

INTRODUCTION

Over 60% of premature infants are born in Africa or South Asia. Infants born early, small or who become sick after birth have a higher risk of death, poor growth and developmental impairments. Innovative interventions tailored for low- and middle-income countries are essential to help these newborns survive and develop optimally. This study evaluated the feasibility, acceptability and preliminary effectiveness of Hospital to Home (H2H), a discharge and follow-up programme for small and sick newborns in rural Uganda.

METHODS

We compared two cohorts of high-risk hospitalised neonates in Uganda: a historical-comparison cohort receiving standard facility-based care and an intervention cohort that received the H2H programme, a hospital and community spanning package of interventions designed to improve neurodevelopmental outcomes. We compared 6-month corrected neurodevelopmental, growth, nutritional and vaccination outcomes between the cohorts complemented by qualitative interviews of caregivers, community health workers and health facility staff.

RESULTS

We recruited 191 participants: 91 historical-comparison cohort (born between July and September 2018), and 100 intervention cohort (born July 2019 to February 2020). No statistically significant difference was seen in neurodevelopmental outcomes (adjusted OR 0.68; 95% CI: 0.32 to 1.46). Improved vaccination completion (88.5% intervention vs 76.9% comparison, p=0.041), and exclusive breastfeeding rates (42% vs 6.6%, p<0.001) were seen. Caregivers and healthcare workers reported the intervention to be acceptable and feasible in this rural Ugandan setting.

CONCLUSION

The H2H programme was feasible and acceptable to caregivers and healthcare providers. Improved vaccination and exclusive breastfeeding rates were seen in the intervention group when compared with a historical comparison cohort in this rural Ugandan setting. Further investigation on the short and long-term effectiveness of the H2H programme in a government health services setting is warranted.

TRIAL REGISTRATION NUMBER

ISRCTN51636372.

摘要

引言

超过60%的早产儿出生在非洲或南亚。早产、出生体重低或出生后患病的婴儿死亡风险更高，生长发育不良。为低收入和中等收入国家量身定制的创新干预措施对于帮助这些新生儿存活并实现最佳发育至关重要。本研究评估了“医院到家”（H2H）项目的可行性、可接受性和初步效果，该项目是乌干达农村地区针对患病低体重新生儿的出院及随访项目。

方法

我们比较了乌干达两组高危住院新生儿：一组是接受基于医疗机构标准护理的历史对照队列，另一组是接受H2H项目的干预队列，该项目是一套涵盖医院和社区的干预措施，旨在改善神经发育结局。我们比较了两组之间6个月校正后的神经发育、生长、营养和疫苗接种结局，并辅以对照顾者、社区卫生工作者和医疗机构工作人员的定性访谈。

结果

我们招募了191名参与者：91名历史对照队列（2018年7月至9月出生），100名干预队列（2019年7月至2020年2月出生）。神经发育结局未见统计学显著差异（调整后比值比0.68；95%置信区间：0.32至1.46）。疫苗接种完成率有所提高（干预组为88.5%，对照组为76.9%，p = 0.041），纯母乳喂养率也有所提高（42%对6.6%，p < 0.001）。照顾者和医护人员报告称，该干预措施在乌干达农村地区是可接受且可行的。