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 site of the proposed research, the current standard of care does not include follow-up of post-operative surgical patients. There, a network of community health workers (CHWs) are 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 first aim of this study is to optimize a screening protocol to identify SSI in patients receivig surgery at Kirehe District Hospital (KDH) 10 days post-operation. This initial phase of research will involve screening 450 patients first by a general practitioner and then by a surgical CHW (sCHW) using a six question protocol. The protocol will undergo an optimization procedure and the final sensitivity and specificity reported.
The second aim i s to evaluate the impact of 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, 400 patients will be assigned to each of these delivery arms, and the rates of appropriate return to care will be compared to that of 400 patients in a control arm receiving the standard of care (i.e. no follow-up). Process indicators also will be reported to describe the feasibility of CHW-mHealth interventions. We 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 o similar mHealth interventions across other disease areas, allowing CHWs to expand services to other specialized patients in rural African settings.
Surgical site infections represent a major source of morbidity and mortality worldwide and are disproportionately felt in low- and middle-income countries. Geographic and financial barriers can lead to delayed return to care with post-operative complications in rural Rwanda. This proposed research will develop an mHealth protocol to identify surgical site infections 10 days post-operation and will evaluate the impact of a program of mHealth-supported community health workers on timely and appropriate return to care of patients with surgical site infections in Rwanda, improving patient outcomes and reducing healthcare costs.
