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

项目摘要/摘要 撒哈拉以南非洲剖腹产机会的改善带来了新的挑战，特别是增加了 手术部位感染(SSI)。据估计，该地区7%-12%的剖腹产妇女 发展SSI，通常在他们出院后。距离和经济障碍可能会阻止或推迟 这可能会导致产妇发病率和死亡率增加。最近的扩张 撒哈拉以南非洲的宽带蜂窝网络覆盖提供了一个机会，可以探索这些 使用远程医疗对妇女进行远程跟踪、准确诊断SSI以及 将那些有SSIS风险的人与护理联系起来。 我们提出了一种用于农村SSI监测的mHealth-CHW光增强筛查(MC-PES)干预方法 卢旺达。社区卫生工作者将在手术后大约10天探望妇女，实施有效的 三个问题的临床评估，拍摄伤口的照片，并将此信息传递给一位将军 将提供SSI实时诊断的从业者。被诊断为SSI的患者将被转介到 在医院接受治疗。 我们的目标是评估MC-PES干预的可行性、可接受性和诊断效果。这个 前瞻性干预将包括421名接受剖腹产的妇女。我们将评估 通过评估一套成功实施措施的百分比来评估研究的可行性 完成。为了确定患者和提供者对MC-PES的接受程度，我们将采访15名登记的患者 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，为了评估诊断效果，我们将比较接受VIA的SSI诊断女性 MC-PES干预对全科医生体检结果的影响 考虑一下金本位制。我们还将使用伤口照片和SSI诊断来评估诊断的准确性， 我们之前在一项正在进行的研究中收集了521名女性的数据。 这项研究的结果将为农村剖宫产产妇的术后随访提供依据。 非洲的一些地区。此外，这项研究将提供关于移动健康和远程医疗干预是否可以 可用于撒哈拉以南非洲更广泛的临床随访。

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.