Using mHealth Technology to Identify and Refer Surgical Site Infections in Rwanda

Study Overview
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Brief Summary
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The present study aims to examine whether or not the use of mobile Health (mHealth) by community health workers (CHWs) can improve the identification of surgical site infection (SSI) and a timely return to care among patients who undergo cesarean-section surgery at a rural hospital in Rwanda.

Detailed Description
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Surgical site infections (SSI) are a significant cause of morbidity and mortality worldwide, and particularly in low- and middle-income countries, where geographic and infrastructural barriers often delay or prevent post-operative patients from returning to care. In these settings, rates of SSI can reach 30%. In Rwanda, the current standard of care does not include follow-up of post-operative surgical patients. There, a network of community health workers (CHWs) is employed to provide care and follow-up for pregnant and post-partum women as well as children under five years of age. However, the limited education and existing work load of these workers preclude them from supporting the follow-up of other specialized conditions, such as post-operative patients. The interventions evaluated in this proposed research seeks to address these gaps. The main aim is to evaluate the impact of the SSI screening protocol, delivered by sCHWs equipped with mHealth support, on the rate of return to care for patients with SSI 10 days post-operation. Two CHW-mHealth interventions will be evaluated. In the first, a sCHW will visit post-operative study participants in their homes to administer the screening protocol prompted by the mobile phone. In the second, a sCHW will call the patient and administer the same screening protocol over the phone. In this phase of the research, 364 patients will be assigned to each of these delivery arms, and the rates of appropriate return to care will be compared to that of 364 patients in a control arm receiving the standard of care (i.e. no additional follow-up). Process indicators also will be reported to describe the feasibility of CHW-mHealth interventions. Investigators believe that the SSI screening protocol administered via CHW-mHealth interventions can support accurate diagnosis of SSI and refer patients back to the hospital for appropriate follow-up care. The research team's close collaboration with colleagues at the Rwanda Ministry of Health will facilitate the scale-up of the intervention, should it prove efficacious. Results of this study will also inform the development of similar mHealth interventions across other disease areas, allowing CHWs to expand services to other specialized patients in rural African settings.

Official Title
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Using mHealth Technology to Identify and Refer Surgical Site Infections in Rwanda

Conditions
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Surgical Site Infection

Intervention / Treatment
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* Other: SSI Screening Tool used in home visits by CHWs
* Other: SSI Screening Tool used via phone call follow-up


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients that have undergone cesarean-section surgery at Kirehe District Hospital Exclusion Criteria: Patients from Mahama Refugee Camp will not be asked to participate in follow-up activities due to travel autonomy issues Patients that are not residents of Kirehe District Patients that have surgery other than cesarean delivery Patients that have not been discharged by 7 post-operative days (POD)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Home Visit<br>Individuals in Arm 1 will be visited at home by the sCHW who will administer the optimized SSI protocol via the mHealth device. Intervention: SSI Screening Tool used in home visits by CHWs | Other: SSI Screening Tool used in home visits by CHWs<br>* Individuals in Arm 1 will be visited at home by the sCHW who will administer the optimized SSI protocol via the mHealth device. Following the screening, the sCHWs will use the cell phone to photograph the surgical wound and record the GPS location of the visit.<br>|
| Experimental: Phone Call<br>Individuals in Arm 2 will be phoned by the sCHW who will administer the SSI protocol over the phone. Intervention: SSI Screening Tool used via phone call follow-up | Other: SSI Screening Tool used via phone call follow-up<br>* Individuals in Arm 2 will be phoned by the sCHW who will administer the SSI protocol over the phone.<br>|
| No Intervention: Standard of Care<br>Individuals in Arm 3 will not have any additional contact beyond standard of care. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patients with SSI returning to care | The number of patients in each study arm who return to care with a surgical site infection. | by 20 days post-surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Surgical Site Infection, mHealth, Cesarean Section