Using mobile health technology and community health workers to identify and refer caesarean-related surgical site infections in rural Rwanda: a randomised controlled trial protocol

Kristin A Sonderman, Theoneste Nkurunziza, Fredrick Kateera, Magdalena Gruendl, Rachel Koch, Erick Gaju, Caste Habiyakare, Alexi Matousek, Evrard Nahimana, Georges Ntakiyiruta, Robert Riviello, Bethany L Hedt-Gauthier, Kristin A Sonderman, Theoneste Nkurunziza, Fredrick Kateera, Magdalena Gruendl, Rachel Koch, Erick Gaju, Caste Habiyakare, Alexi Matousek, Evrard Nahimana, Georges Ntakiyiruta, Robert Riviello, Bethany L Hedt-Gauthier

Abstract

Introduction: Surgical site infections (SSIs) are a significant cause of morbidity and mortality in low-income and middle-income countries, where rates of SSIs can reach 30%. Due to limited access, there is minimal follow-up postoperatively. Community health workers (CHWs) have not yet been used for surgical patients in most settings. Advancements in telecommunication create an opportunity for mobile health (mHealth) tools to support CHWs. We aim to evaluate the use of mHealth technology to aid CHWs in identification of SSIs and promote referral of patients back to healthcare facilities.

Methods and analysis: Prospective randomised controlled trial conducted at Kirehe District Hospital, Rwanda, from November 2017 to November 2018. Patients ≥18 years who undergo caesarean section are eligible. Non-residents of Kirehe District or patients who remain in hospital >10 days postoperatively will be excluded. Patients will be randomised to one of three arms. For arm 1, a CHW will visit the patient's home on postoperative day 10 (±3 days) to administer an SSI screening protocol (fever, pain or purulent drainage) using an electronic tablet. For arm 2, the CHW will administer the screening protocol over the phone. For both arms 1 and 2, the CHW will refer patients who respond 'yes' to any of the questions to a health facility. For arm 3, patients will not receive follow-up care. Our primary outcome will be the impact of the mHealth-CHW intervention on the rate of return to care for patients with an SSI.

Ethics and dissemination: The study has received ethical approval from the Rwandan National Ethics Committee and Partners Healthcare. Results will be disseminated to Kirehe District Hospital, Rwanda Ministry of Health, Rwanda Surgical Society, Partners In Health, through conferences and peer-reviewed publications.

Trial registration number: NCT03311399.

Keywords: mobile health; surgery; surgical site infections.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Study design. CHW, community health workers; POD, post operative day; SSI, surgical site infection.

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