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: 10019000
• 负责人: Bethany Hedt-Gauthier
• 金额: $ 8万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10019000
• 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/文摘

项目成果

Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment.

• DOI: 10.5334/aogh.3416
• 发表时间: 2021
• 期刊: Annals of global health
• 影响因子: 2.9
• 作者: Umutesi G;Velin L;Muwanguzi M;Faktor K;Mugabo C;Rukundo G;Rucogoza A;Yankurije M;Mazimpaka C;de Dieu Gatete J;Shyirambere C;Hedt-Gauthier B;Riviello R;Mpunga T;Mwikarago EI;Kateera F
• 通讯作者: Kateera F

mHealth-community health worker telemedicine intervention for surgical site infection diagnosis: a prospective study among women delivering via caesarean section in rural Rwanda.

• DOI: 10.1136/bmjgh-2022-009365
• 发表时间: 2022-07
• 期刊: BMJ GLOBAL HEALTH
• 影响因子: 8.1
• 作者: Nkurunziza, Theoneste;Williams, Wendy;Kateera, Fredrick;Riviello, Robert;Niyigena, Anne;Miranda, Elizabeth;Bikorimana, Laban;Nkurunziza, Jonathan;Velin, Lotta;Goodman, Andrea S.;Matousek, Alex;Klug, Stefanie J.;Gaju, Erick;Hedt-Gauthier, Bethany L.
• 通讯作者: Hedt-Gauthier, Bethany L.

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda.

剖宫产后的功能恢复：卢旺达农村的一项前瞻性队列研究。

• DOI: 10.1186/s12884-023-06159-3
• 发表时间: 2023-12-13
• 期刊: BMC pregnancy and childbirth
• 影响因子: 3.1

Using mobile health technology and community health workers to identify and refer caesarean-related surgical site infections in rural Rwanda: a randomised controlled trial protocol.

使用移动医疗技术和社区卫生工作者来识别和转介卢旺达农村地区与剖腹产相关的手术部位感染：一项随机对照试验方案。

• DOI: 10.1136/bmjopen-2018-022214
• 发表时间: 2018
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Sonderman,KristinA;Nkurunziza,Theoneste;Kateera,Fredrick;Gruendl,Magdalena;Koch,Rachel;Gaju,Erick;Habiyakare,Caste;Matousek,Alexi;Nahimana,Evrard;Ntakiyiruta,Georges;Riviello,Robert;Hedt-Gauthier,BethanyL
• 通讯作者: Hedt-Gauthier,BethanyL

Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda.

• DOI: 10.5334/aogh.3413
• 发表时间: 2021
• 期刊: Annals of global health
• 影响因子: 2.9
• 作者: Velin L;Umutesi G;Riviello R;Muwanguzi M;Bebell LM;Yankurije M;Faktor K;Nkurunziza T;Rukundo G;de Dieu Gatete J;Emil I;Hedt-Gauthier BL;Kateera F
• 通讯作者: Kateera F