Telemedicine to improve the diagnosis of surgical site infections post-cesarean delivery in rural Rwanda

远程医疗可改善卢旺达农村地区剖腹产后手术部位感染的诊断

• 批准号: 9895899
• 负责人: Bethany Hedt-Gauthier
• 金额: $ 1.65万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-22 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9895899
• 关键词: Address; Africa; Africa South of the Sahara; Algorithms; Archives; Area; Back; Caring; Cesarean section; Clinical; Clinical assessments; Community Health Aides; Community Health Networks; Country; Data; Detection; Diagnosis; Diagnostic; Enrollment; Evaluation; Face; Failure; Feasibility Studies; General Hospitals; General Practitioners; Goals; Gold; Health system; Home environment; Hospitals; Improve Access; Infection; Intervention; Interview; Lead; Link; Maternal Mortality; Measures; Methods; Monitor; Morbidity - disease rate; Mothers; Operative Surgical Procedures; Outcome; Patients; Physical Examination; Postoperative Complications; Postoperative Period; Provider; Rural; Rwanda; Sensitivity and Specificity; Site; Telemedicine; Text; Time; Travel; United States; Visit; Woman; accurate diagnosis; base; cohort; cost; design; diagnostic accuracy; follow-up; improved; innovation; insight; mHealth; maternal morbidity; mortality; patient response; prevent; prospective; response; rural area; screening; surgical risk; wound

Project Summary/Abstract Improved access to cesarean delivery in sub-Saharan Africa has led to new challenges, particularly an increase in surgical site infections (SSIs). An estimated 7-12% of women who have cesarean sections in the region develop SSIs, often after they are discharged from hospitals. Distance and financial barriers can prevent or delay them returning for care, and this can lead to increased maternal morbidity and mortality. Recent expansion of broadband cellular network coverage in sub-Saharan Africa provides an opportunity to explore whether these problems can be solved using telemedicine to follow-up with women remotely, accurately diagnose SSIs, and link those at risk of SSIs back to care. We propose a mHealth-CHW Photo-Enhanced Screening (mC-PES) intervention for SSI monitoring in rural Rwanda. Community health workers will visit women approximately 10 days after surgery, administer a validated three-question clinical assessment, take a photo of the wound, and transmit this information to a general practitioner who will provide an SSI diagnosis in real time. Patients diagnosed with an SSI will be referred to a hospital for care. Our goal is to assess the feasibility, acceptability, and diagnostic efficacy of the mC-PES intervention. The prospective intervention will include a cohort of 421 women receiving cesarean sections. We will evaluate the study's feasibility by assessing the percent of a certain set of implementation measures that are successfully completed. To determine how acceptable mC-PES is to patients and providers, we will interview 15 enrolled mothers, 14 hospital general practitioners, and 15 community health workers and use a Framework Analysis to analyze the data. Finally, to evaluate diagnostic efficacy, we will compare SSI diagnoses women that receive via the mC-PES interventions to that resulting from physical examinations by general practitioners, which we consider the gold standard. We will also assess the diagnostic accuracy using wound photos and SSI diagnoses, for 521 women whose data we previously collected as part of an ongoing study. The results from this study will inform postoperative follow-up for women delivering via cesarean section in rural areas of Africa. Further, the study will provide insight on whether mHealth and telemedicine interventions could be used for a broader range of clinical follow-up in sub-Saharan Africa.

项目总结/摘要 在撒哈拉以南非洲，剖腹产服务的改善带来了新的挑战， 手术部位感染（SSI）。据估计，该地区有7-12%的剖宫产妇女 发展SSI，通常是在他们出院后。距离和经济障碍可以阻止或延迟 这可能导致孕产妇发病率和死亡率上升。最近扩大 撒哈拉以南非洲的宽带蜂窝网络覆盖提供了一个机会，以探索这些 使用远程医疗可以解决问题，远程跟踪妇女，准确诊断SSI， 将那些有SSI风险的人重新联系起来。 我们提出了一个mHealth-CHW照片增强筛查（mC-PES）干预措施，用于农村SSI监测 卢旺达.社区卫生工作者将在手术后约10天访问妇女， 三个问题的临床评估，拍下伤口的照片，并将此信息传递给一个将军。 将提供真实的SSI诊断的医生。被诊断为SSI的患者将被转诊至 医院护理 我们的目标是评估mC-PES干预的可行性、可接受性和诊断功效。的 前瞻性干预将包括421名接受剖腹产的妇女。我们将评估 研究的可行性，通过评估成功的实施措施的百分比， 完成为了确定患者和医疗服务提供者对mC-PES的接受程度，我们将对15名入组患者进行访谈， 母亲，14名医院全科医生和15名社区卫生工作者，并使用框架分析， 分析数据。最后，为了评估诊断的有效性，我们将比较SSI诊断的妇女， mC-PES干预措施，从全科医生的体检，我们 考虑黄金标准。我们还将使用伤口照片和SSI诊断评估诊断准确性， 521名妇女的数据，我们以前收集的一部分，正在进行的研究。 本研究的结果将为农村剖宫产妇女的术后随访提供参考 非洲地区。此外，该研究将提供关于移动健康和远程医疗干预是否可以 用于撒哈拉以南非洲更广泛的临床随访。