Development and evaluation of a mobile application for case management of small and sick newborns in Bangladesh

Lauren E. Schaeffer, Salahuddin Ahmed, Mahmoodur Rahman, Rachel Whelan, Sayedur Rahman, Arunangshu Dutta Roy, Tanzia Ahmed Nijhum, Nazmun Nahar Bably, Helen D'Couto, Carly Hudelson, Iffat Ara Jaben, Sayed Rubayet, Abdullah Baqui, Anne C.C. Lee

Research output: Contribution to journalArticle

Abstract

Background: In low-income settings, community health workers (CHWs) are frequently the first point of contact for newborns. Mobile technology may aid health workers in classifying illness and providing referral and management guidance for newborn care. This study evaluates the potential for mobile health technology to improve diagnosis and case management of newborns in Bangladesh. Methods: A mobile application based on Bangladesh's Comprehensive Newborn Care Package national guidelines (mCNCP) was developed to aid CHWs in identifying and managing small and sick infants. After a 2-day training, CHWs assessed newborns at Sylhet Osmani Medical College Hospital and in the Projahnmo research site (Sylhet, Bangladesh) using either mCNCP or a comparable paper form (pCNCP), similar to standard IMCI-formatted paper forms. CHWs were randomized to conduct a block of ~ 6 newborn assessments starting with either mCNCP or pCNCP, then switched to the alternate method. Physicians using mCNCP served as gold standard assessors. CHW performance with mCNCP and pCNCP were compared using chi-squared tests of independence for equality of proportions, and logistic regressions clustered by CHW. Results: Two hundred seven total CHW assessments were completed on 101 enrolled infants. mCNCP assessments were more often fully completed and completed faster than pCNCP assessments (100% vs 23.8%, p < 0.001; 17.5 vs 23.6 min; p < 0.001). mCNCP facilitated calculations of respiratory rate, temperature, and gestational age. CHWs using mCNCP were more likely to identify small newborns (Odds Ratio (OR): 20.8, Confidence Interval (CI): (7.1, 60.8), p < 0.001), and to correctly classify 7 out of 16 newborn conditions evaluated, including severe weight loss (OR: 13.1, CI: (4.6, 37.5), p < 0.001), poor movement (OR: 6.6, CI: (2.3, 19.3), p = 0.001), hypothermia (OR: 14.9, CI: (2.7, 82.2), p = 0.002), and feeding intolerance (OR: 2.1, CI: (1.3, 3.3), p = 0.003). CHWs with mCNCP were more likely to provide counseling as needed on 4 out of 7 case management recommendations evaluated, including kangaroo mother care. Conclusions: CHWs in rural Bangladesh with limited experience using tablets successfully used a mobile application for neonatal assessment after a two-day training. mCNCP may aid frontline health workers in Bangladesh to improve completion of neonatal assessment, classification of illnesses, and adherence to neonatal management guidelines.

Original languageEnglish (US)
Article number116
JournalBMC medical informatics and decision making
Volume19
Issue number1
DOIs
StatePublished - Jun 20 2019

Fingerprint

Mobile Applications
Bangladesh
Case Management
Newborn Infant
Odds Ratio
Confidence Intervals
Kangaroo-Mother Care Method
Guidelines
Biomedical Technology
Telemedicine
Health
Respiratory Rate
Hypothermia
Tablets
Gestational Age
Counseling
Weight Loss
Referral and Consultation
Logistic Models

Keywords

  • Bangladesh clinical guidelines
  • Community health worker
  • Comprehensive Newborn Care Package
  • Integrated Management of Childhood Illnesses
  • m-Health
  • mCNCP
  • Newborn assessment
  • Newborn care
  • Newborn case management
  • Newborn danger signs
  • User-centered design

ASJC Scopus subject areas

  • Health Policy
  • Health Informatics

Cite this

Development and evaluation of a mobile application for case management of small and sick newborns in Bangladesh. / Schaeffer, Lauren E.; Ahmed, Salahuddin; Rahman, Mahmoodur; Whelan, Rachel; Rahman, Sayedur; Roy, Arunangshu Dutta; Nijhum, Tanzia Ahmed; Bably, Nazmun Nahar; D'Couto, Helen; Hudelson, Carly; Jaben, Iffat Ara; Rubayet, Sayed; Baqui, Abdullah; Lee, Anne C.C.

In: BMC medical informatics and decision making, Vol. 19, No. 1, 116, 20.06.2019.

Research output: Contribution to journalArticle

Schaeffer, LE, Ahmed, S, Rahman, M, Whelan, R, Rahman, S, Roy, AD, Nijhum, TA, Bably, NN, D'Couto, H, Hudelson, C, Jaben, IA, Rubayet, S, Baqui, A & Lee, ACC 2019, 'Development and evaluation of a mobile application for case management of small and sick newborns in Bangladesh', BMC medical informatics and decision making, vol. 19, no. 1, 116. https://doi.org/10.1186/s12911-019-0835-7
Schaeffer, Lauren E. ; Ahmed, Salahuddin ; Rahman, Mahmoodur ; Whelan, Rachel ; Rahman, Sayedur ; Roy, Arunangshu Dutta ; Nijhum, Tanzia Ahmed ; Bably, Nazmun Nahar ; D'Couto, Helen ; Hudelson, Carly ; Jaben, Iffat Ara ; Rubayet, Sayed ; Baqui, Abdullah ; Lee, Anne C.C. / Development and evaluation of a mobile application for case management of small and sick newborns in Bangladesh. In: BMC medical informatics and decision making. 2019 ; Vol. 19, No. 1.
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T1 - Development and evaluation of a mobile application for case management of small and sick newborns in Bangladesh

AU - Schaeffer, Lauren E.

AU - Ahmed, Salahuddin

AU - Rahman, Mahmoodur

AU - Whelan, Rachel

AU - Rahman, Sayedur

AU - Roy, Arunangshu Dutta

AU - Nijhum, Tanzia Ahmed

AU - Bably, Nazmun Nahar

AU - D'Couto, Helen

AU - Hudelson, Carly

AU - Jaben, Iffat Ara

AU - Rubayet, Sayed

AU - Baqui, Abdullah

AU - Lee, Anne C.C.

PY - 2019/6/20

Y1 - 2019/6/20

N2 - Background: In low-income settings, community health workers (CHWs) are frequently the first point of contact for newborns. Mobile technology may aid health workers in classifying illness and providing referral and management guidance for newborn care. This study evaluates the potential for mobile health technology to improve diagnosis and case management of newborns in Bangladesh. Methods: A mobile application based on Bangladesh's Comprehensive Newborn Care Package national guidelines (mCNCP) was developed to aid CHWs in identifying and managing small and sick infants. After a 2-day training, CHWs assessed newborns at Sylhet Osmani Medical College Hospital and in the Projahnmo research site (Sylhet, Bangladesh) using either mCNCP or a comparable paper form (pCNCP), similar to standard IMCI-formatted paper forms. CHWs were randomized to conduct a block of ~ 6 newborn assessments starting with either mCNCP or pCNCP, then switched to the alternate method. Physicians using mCNCP served as gold standard assessors. CHW performance with mCNCP and pCNCP were compared using chi-squared tests of independence for equality of proportions, and logistic regressions clustered by CHW. Results: Two hundred seven total CHW assessments were completed on 101 enrolled infants. mCNCP assessments were more often fully completed and completed faster than pCNCP assessments (100% vs 23.8%, p < 0.001; 17.5 vs 23.6 min; p < 0.001). mCNCP facilitated calculations of respiratory rate, temperature, and gestational age. CHWs using mCNCP were more likely to identify small newborns (Odds Ratio (OR): 20.8, Confidence Interval (CI): (7.1, 60.8), p < 0.001), and to correctly classify 7 out of 16 newborn conditions evaluated, including severe weight loss (OR: 13.1, CI: (4.6, 37.5), p < 0.001), poor movement (OR: 6.6, CI: (2.3, 19.3), p = 0.001), hypothermia (OR: 14.9, CI: (2.7, 82.2), p = 0.002), and feeding intolerance (OR: 2.1, CI: (1.3, 3.3), p = 0.003). CHWs with mCNCP were more likely to provide counseling as needed on 4 out of 7 case management recommendations evaluated, including kangaroo mother care. Conclusions: CHWs in rural Bangladesh with limited experience using tablets successfully used a mobile application for neonatal assessment after a two-day training. mCNCP may aid frontline health workers in Bangladesh to improve completion of neonatal assessment, classification of illnesses, and adherence to neonatal management guidelines.

AB - Background: In low-income settings, community health workers (CHWs) are frequently the first point of contact for newborns. Mobile technology may aid health workers in classifying illness and providing referral and management guidance for newborn care. This study evaluates the potential for mobile health technology to improve diagnosis and case management of newborns in Bangladesh. Methods: A mobile application based on Bangladesh's Comprehensive Newborn Care Package national guidelines (mCNCP) was developed to aid CHWs in identifying and managing small and sick infants. After a 2-day training, CHWs assessed newborns at Sylhet Osmani Medical College Hospital and in the Projahnmo research site (Sylhet, Bangladesh) using either mCNCP or a comparable paper form (pCNCP), similar to standard IMCI-formatted paper forms. CHWs were randomized to conduct a block of ~ 6 newborn assessments starting with either mCNCP or pCNCP, then switched to the alternate method. Physicians using mCNCP served as gold standard assessors. CHW performance with mCNCP and pCNCP were compared using chi-squared tests of independence for equality of proportions, and logistic regressions clustered by CHW. Results: Two hundred seven total CHW assessments were completed on 101 enrolled infants. mCNCP assessments were more often fully completed and completed faster than pCNCP assessments (100% vs 23.8%, p < 0.001; 17.5 vs 23.6 min; p < 0.001). mCNCP facilitated calculations of respiratory rate, temperature, and gestational age. CHWs using mCNCP were more likely to identify small newborns (Odds Ratio (OR): 20.8, Confidence Interval (CI): (7.1, 60.8), p < 0.001), and to correctly classify 7 out of 16 newborn conditions evaluated, including severe weight loss (OR: 13.1, CI: (4.6, 37.5), p < 0.001), poor movement (OR: 6.6, CI: (2.3, 19.3), p = 0.001), hypothermia (OR: 14.9, CI: (2.7, 82.2), p = 0.002), and feeding intolerance (OR: 2.1, CI: (1.3, 3.3), p = 0.003). CHWs with mCNCP were more likely to provide counseling as needed on 4 out of 7 case management recommendations evaluated, including kangaroo mother care. Conclusions: CHWs in rural Bangladesh with limited experience using tablets successfully used a mobile application for neonatal assessment after a two-day training. mCNCP may aid frontline health workers in Bangladesh to improve completion of neonatal assessment, classification of illnesses, and adherence to neonatal management guidelines.

KW - Bangladesh clinical guidelines

KW - Community health worker

KW - Comprehensive Newborn Care Package

KW - Integrated Management of Childhood Illnesses

KW - m-Health

KW - mCNCP

KW - Newborn assessment

KW - Newborn care

KW - Newborn case management

KW - Newborn danger signs

KW - User-centered design

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DO - 10.1186/s12911-019-0835-7

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