Protocol for an intervention development and pilot implementation evaluation study of an e-health solution to improve newborn care quality and survival in two low-resource settings, Malawi and Zimbabwe: Neotree

Emma Wilson¹, Hannah Gannon¹, Gwendoline Chimhini², Felicity Fitzgerald³, Nushrat Khan¹, Fabiana Lorencatto⁴, Erin Kesler⁵, Deliwe Nkhoma⁶, Tarisai Chiyaka⁷, Hassan Haghparast-Bidgoli⁸, Monica Lakhanpaul¹, Mario Cortina Borja¹, Alexander G Stevenson⁹, Caroline Crehan¹, Yali Sassoon¹⁰, Tim Hull-Bailey¹, Kristina Curtis⁴, Msandeni Chiume¹¹, Simbarashe Chimhuya¹², Michelle Heys¹³

Affiliations

¹ Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
² Unit of Child and Adolescent Health, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe.
³ Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, London, UK.
⁴ UCL Centre for Behaviour Change, London, UK.
⁵ The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁶ Parent and Child Health Initiative Trust, Lilongwe, Central Region, Malawi.
⁷ Biomedical Research and Training Institute, Harare, Zimbabwe.
⁸ UCL Institute for Global Health, London, UK.
⁹ Mbuya Nehanda Maternity Hospital, Harare, Zimbabwe.
¹⁰ Snowplow Analytics, London, UK.
¹¹ Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi.
¹² Unit of Child and Adolescent Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
¹³ Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK m.heys@ucl.ac.uk.

PMID: 35790332
PMCID: PMC9258512
DOI: 10.1136/bmjopen-2021-056605

Protocol for an intervention development and pilot implementation evaluation study of an e-health solution to improve newborn care quality and survival in two low-resource settings, Malawi and Zimbabwe: Neotree

Emma Wilson et al. BMJ Open. 2022.

. 2022 Jul 5;12(7):e056605.

doi: 10.1136/bmjopen-2021-056605.

Authors

Affiliations

¹ Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
² Unit of Child and Adolescent Health, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe.
³ Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, London, UK.
⁴ UCL Centre for Behaviour Change, London, UK.
⁵ The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁶ Parent and Child Health Initiative Trust, Lilongwe, Central Region, Malawi.
⁷ Biomedical Research and Training Institute, Harare, Zimbabwe.
⁸ UCL Institute for Global Health, London, UK.
⁹ Mbuya Nehanda Maternity Hospital, Harare, Zimbabwe.
¹⁰ Snowplow Analytics, London, UK.
¹¹ Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi.
¹² Unit of Child and Adolescent Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
¹³ Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK m.heys@ucl.ac.uk.

PMID: 35790332
PMCID: PMC9258512
DOI: 10.1136/bmjopen-2021-056605

Abstract

Introduction: Every year 2.4 million deaths occur worldwide in babies younger than 28 days. Approximately 70% of these deaths occur in low-resource settings because of failure to implement evidence-based interventions. Digital health technologies may offer an implementation solution. Since 2014, we have worked in Bangladesh, Malawi, Zimbabwe and the UK to develop and pilot Neotree: an android app with accompanying data visualisation, linkage and export. Its low-cost hardware and state-of-the-art software are used to improve bedside postnatal care and to provide insights into population health trends, to impact wider policy and practice.

Methods and analysis: This is a mixed methods (1) intervention codevelopment and optimisation and (2) pilot implementation evaluation (including economic evaluation) study. Neotree will be implemented in two hospitals in Zimbabwe, and one in Malawi. Over the 2-year study period clinical and demographic newborn data will be collected via Neotree, in addition to behavioural science informed qualitative and quantitative implementation evaluation and measures of cost, newborn care quality and usability. Neotree clinical decision support algorithms will be optimised according to best available evidence and clinical validation studies.

Ethics and dissemination: This is a Wellcome Trust funded project (215742_Z_19_Z). Research ethics approvals have been obtained: Malawi College of Medicine Research and Ethics Committee (P.01/20/2909; P.02/19/2613); UCL (17123/001, 6681/001, 5019/004); Medical Research Council Zimbabwe (MRCZ/A/2570), BRTI and JREC institutional review boards (AP155/2020; JREC/327/19), Sally Mugabe Hospital Ethics Committee (071119/64; 250418/48). Results will be disseminated via academic publications and public and policy engagement activities. In this study, the care for an estimated 15 000 babies across three sites will be impacted.

Trial registration number: NCT0512707; Pre-results.

Trial registration: ClinicalTrials.gov NCT00512707.

Keywords: health informatics; neonatology; quality in health care.

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Conflict of interest statement

Competing interests: MH, YS, EK and FF are trustees of the Neotree charity (www.neotree.org) but receive no financial payment from this role. CC was a trustee of the Neotree charity until 2018 and received no financial payment for this role.

References

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1. Moxon SG, Lawn JE, Dickson KE, et al. Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth 2015;15 Suppl 2:S7. 10.1186/1471-2393-15-S2-S7 - DOI - PMC - PubMed
1. World Health Organisation . Standards for improving quality of maternal and newborn care in health facilities. Geneva: WHO, 2016. https://apps.who.int/iris/bitstream/handle/10665/249155/9789241511216-en...

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Protocol for an intervention development and pilot implementation evaluation study of an e-health solution to improve newborn care quality and survival in two low-resource settings, Malawi and Zimbabwe: Neotree

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Protocol for an intervention development and pilot implementation evaluation study of an e-health solution to improve newborn care quality and survival in two low-resource settings, Malawi and Zimbabwe: Neotree

Authors

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Abstract

Conflict of interest statement

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