CHV-NEO: Community-based digital communication to support neonatal health

项目摘要/摘要 2017年，250万儿童在出生后第一个月死亡。据估计，这些死亡中有200万人可能是 通过在家中提供基本的新生儿护理以及通过以下方式快速识别疾病和寻求护理来预防 照顾者。社区卫生志愿者(CHV)是一大批非专业卫生工作者，他们的作用是 促进在资源有限的情况下获得预防性护理和治疗。在肯尼亚，CHV每月进行一次 对孕妇和产后妇女进行家访，以提供教育和筛查并发症。几个 肯尼亚各县已采用数字社区卫生工具包(DCHT)，通过以下方式支持CHV工作流程 跟踪客户、管理任务和指导家访。标准化的CHV家访扩大了母亲的 获得信息和支持，然而，在#年的头几周，新生儿疾病的集中风险 生活及其迅速恶化的可能性意味着，即使是每月的家访也会让母亲和 需要按需支持的新生儿。 我们的团队开发了一种交互式短信短信干预工具Mobile Wach Neo(NEO)，它可以连接 母亲与医护人员远程配合，在产后高危时期立即改善孕产妇 和新生儿健康。NEO发送自动化的、基于理论的、可操作的日常消息，系统地指导 母亲评估新生儿危险迹象，并促进与医护人员的实时对话以进行分类 医疗问题，并加强产妇的社会支持。 这项提议的首要目标是将NEO交互式短消息整合到现有的数字 支持肯尼亚西部CHV工作流程的基础设施(DCHT)，通过以下方式实现远程通信 母亲在两次家访之间感染了CHV。我们提出了以下具体目标。目标1：雇佣一个人- 以中心为中心的设计方法，开发了dCHT中的NEO交互短信模块，名为CHV-NEO。目标2： 评估CHV-NEO对新生儿死亡率、门诊就诊次数和照顾者提供必要的 新生儿护理(脐带护理、体温护理和开始母乳喂养)，这是一项务实的整群随机试验。 目的3：确定CHV-neo对CHV和主管工作流程的影响，并评估CHV-neo的决定因素 近地天体的可接受性、认可度和使用的保真度。我们假设这一创新战略将会成功 在现有的CHV基础设施内实施，并将改善家庭预防性护理的提供，增加 及时将新生儿疾病转诊至医疗机构，降低新生儿死亡率。 CHV-NEO有潜力解决在资源有限的环境中改善新生儿健康的努力中的一个关键差距。 完成这些目标将产生现成的规模干预和严格的数据， 它的有效性和成功实施的助推器。

PROJECT SUMMARY/ABSTRACT In 2017, 2.5 million children died in the first month of life. An estimated 2 million of these deaths could have been prevented by provision of essential newborn care at home and rapid identification of illness and care-seeking by the caregiver. Community health volunteers (CHVs) are a large cadre of lay health workers whose role is to promote access to preventative care and treatment in resource-limited settings. In Kenya, CHVs conduct monthly home visits to pregnant and postpartum women to provide education and screen for complications. Several counties in Kenya have adopted a digital community health toolkit (dCHT) that supports CHV workflow by tracking clients, managing tasks, and guiding home visits. Standardized CHV home visits expand mothers’ access to information and support, however the concentrated risk of neonatal illness in the first weeks of life and its potential to rapidly deteriorate mean that even monthly home visits leave mothers and neonates in need of on-demand support. Our team developed an interactive SMS text messaging intervention, Mobile WACh Neo (NEO), that connects mothers with healthcare workers remotely in the high-risk period immediately following birth to improve maternal and neonatal health. NEO sends automated, theory-based, actionable daily messages that systematically guide mothers to evaluate neonatal danger signs, and facilitates real-time dialogue with a healthcare worker to triage medical concerns and augment maternal social support. The overarching goal of this proposal is to integrate NEO interactive SMS into the existing digital infrastructure supporting CHV workflow in Western Kenya (dCHT) to enable remote communication by mothers with CHVs between home visits. We propose the following specific aims. Aim 1: Employ a human- centered design approach to develop a NEO interactive SMS module in the dCHT, named CHV-NEO. Aim 2: Evaluate CHV-NEO’s impact on neonatal mortality, clinic visit attendance, and caregiver provision of essential newborn care (cord care, thermal care and initiation of breastfeeding), in a pragmatic cluster-randomized trial. Aim 3: Determine the effect of CHV-NEO on CHV and supervisor workflow, and evaluate determinants of CHV- NEO’s acceptability, adoption and fidelity of use. We hypothesize that this innovative strategy will be successfully implemented within existing CHV infrastructure and will improve provision of at-home preventative care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. CHV-NEO has potential to address a critical gap in efforts to improve neonatal health in resource-limited settings. Completion of these aims will generate a ready-to-scale intervention and rigorous data on both its effectiveness and the enablers of its successful implementation.