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

项目总结/摘要 2017年，有250万儿童在出生后的第一个月内死亡。据估计，其中200万人可能是 通过在家中提供基本的新生儿护理和迅速查明疾病和寻求护理， 照顾者社区卫生志愿者（CHV）是一个庞大的非专业卫生工作者骨干队伍，其作用是 促进在资源有限的环境中获得预防保健和治疗。在肯尼亚，社区卫生车每月 对孕妇和产后妇女进行家访，提供教育和检查并发症。几 肯尼亚各县采用了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，但新生儿疾病的风险集中在出生后的头几周， 生活及其迅速恶化的可能性意味着，即使每月一次的家访， 需要按需支助的新生儿。 我们的团队开发了一种交互式SMS短信干预，移动的WACh Neo（NEO）， 在分娩后的高风险期内，与医护人员远程接触的母亲， 和新生儿健康。NEO发送自动化的、基于理论的、可操作的日常信息，系统地指导 母亲评估新生儿的危险信号，并促进与医疗保健工作者的实时对话，以进行分类 医疗问题和增加产妇的社会支持。 该提案的总体目标是将近地天体互动短信服务纳入现有的数字通信系统， 支持肯尼亚西部CHV工作流程的基础设施， 有丙肝病毒的母亲我们提出以下具体目标。目标1：雇用一个人- 中心化设计方法，在dCHT中开发一个名为CHV-NEO的NEO交互式SMS模块。目标二： 评估CHV-NEO对新生儿死亡率、门诊就诊率和护理人员提供基本护理的影响 新生儿护理（脐带护理、保暖护理和开始母乳喂养），在一项实用的随机分组试验中。 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。 NEO的可接受性、采用性和使用的忠实性。我们假设，这一创新战略将成功地 在现有的CHV基础设施内实施，并将改善家庭预防保健的提供， 及时将新生儿疾病转诊到设施，降低新生儿死亡率。 CHV-NEO有可能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。 这些目标的完成将产生一个现成的规模干预和严格的数据， 有效性和成功执行的促进因素。

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.