NIHR GRP: Increasing newborn survival: harnessing real-time data, digital innovation and community engagement The NIHR Global Research Professorship (GRP) scheme is open to all professions and all Higher Education Institutions (HEI), based in UK and low-and-middle-income-country (LMIC), to nominate health researchers and methodologists with an outstanding research record of clinical and applied health research and its effective translation for improved health. Global Research Professors are required to have existing strong collaborations or links with collaborators or partners in institutions in countries on the OECD DAC list and the award should plan to strengthen these/support training and capacity development/mentorship in these partners.

Vision: to improve the health of newborns and children by building equitable institutional partnerships through which global learning and innovation can flourish. The scientific gap I will address is how to improve newborn care in health facilities in low-resource settings. Every year, around two thirds of the 2.4 million deaths occurring within the first month of life and half of the 2 million stillbirths are likely avoidable by ensuring that the most generalisable (already-well-described) clinical pathways are delivered.

Over the last 7 years I have been working with: families, healthcare providers, software developers, data scientists and the Ministries of Health in Zimbabwe, Malawi and the UK, to co-develop a data driven quality improvement system for hospital-based newborn care. Neotree is a tablet-based application developed with and for nurses and doctors to give better care to newborns, especially in low-resource settings where most newborn health care is delivered by those with little or no training in newborn health. The app guides the healthcare provider through clinical history taking and examination for sick and small babies, providing educational messaging and prompts. This straightforward combination of the key data, education and guidelines is incredibly powerful: not just because it can improve the result for each individual baby, but also because the data can be sent onward to local and national data stores allowing doctors and nurses to look at data for their own population and then improve the guidelines. 

Neotree is open source, and all data captured by the system are owned locally. As of 19/11/2021 the Neotree has been used in two countries to assist the care of ~16,000 newborns by more than 350 healthcare professionals and has been shown to improve quality of care (e.g. more targeted and evidenced based  prescription antibiotics). Plans and funding applications for larger scale testing to assess impact on mortality are underway (out of scope for this application).

Through this Professorship I will extend Neotree to the care of the mother and baby during birth and the care of babies born in rural primary care clinics in Zimbabwe. In addition, I will substantially improve two existing areas: how to use data from the Neotree to improve guidelines, and how we work with families and parents to create partnerships in care - in particular we will find out how best to involve parents in feeding babies and keeping them warm.

I will increase the number of African researchers who are able to conduct research in digital innovation, newborn care and community engagement through (i) supervision and mentorship of African PhD and Masters students and clinicians; (ii) ensuring the Neotree data are curated, easily accessible and reusable and (iii) delivering a 2-year programme in engaging families and communities in newborn research and care. The latter will build on work we have conducted over the last 6 months with families and ArtGlo Africa, a Malawian based participatory arts group, to empower families as active participants in healthcare and research and to strengthen community engagement in newborn care in Malawi and Zimbabwe. I will also mentor a junior researcher in UK-focused community child health. 1. Extend Neotree to new outcomes (quality of perinatal care) and populations (rural health clinics) to help with the care of over a million babies and mothers annually in Zimbabwe and Malawi.
2. Substantially improve neonatal outcomes in communities already using Neotree by optimising clinical care pathways for thermoregulation, convulsions, low birth weight, prematurity, hypoglycaemia, HIV, respiratory distress, neonatal encephalopathy, sepsis, syphilis, jaundice and congenital abnormalities.
3. Actively and explicitly involve families in newborn care research and also in the co-creation of family centred clinical pathways.