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Smart Discharges Uganda Under 5: Phase II clinical data of children 6-60 months - pulse oximetry
Borealis
Wiens, Matthew O; Kabakyenga, Jerome; Kumbakumba, Elias; Kenya-Mugisha, Nathan; Larson, Charles; Moschovis, Peter P; Singer, Joel; Lavoie, Pascal; Dumont, Guy AM; Ansermino, J Mark; Kissoon, Niranjan — 2024-10-22 This data is a subset of the Smart Discharges Uganda Under 5 years parent study and is specific to the Phase II interventional cohort of children aged 6-60 months containing <strong>pulse oximetry</strong> data. <br /> <br /><strong>Background:</strong> Substantial mortality occurs after hospital discharge in children under 5 years old with suspected sepsis. This study aimed to refine and externally validate a previously developed post-discharge mortality prediction model.<br /> <br /><strong>Methods:</strong> In this prospective observational cohort study, we recruited 0-6-month-old children admitted with suspected sepsis from the community to the paediatric wards of six Ugandan hospitals. The primary outcome was six-month post-discharge mortality among those discharged alive. <br /> <br /><strong>Data Collection Methods:</strong> All data were collected at the point of care using encrypted study tablets and these data were then uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses systematically collected data on clinical, social and demographic variables. Following discharge, field officers contacted caregivers at 2 and 4 months by phone, and in-person at 6 months, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for children who had died following discharge.<br /> <br /><strong>Ethics Declaration:</strong> This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (No. 15/10-16), the Uganda National Institute of Science and Technology (HS 2207), and the University of British Columbia / Children & Women’s Health Centre of British Columbia Research Ethics Board (H16-02679). This manuscript adheres to the guidelines for STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.
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Caregivers’ and nurses’ perceptions of the Smart Discharges Program for children with sepsis in Uganda: A qualitative study
Borealis
Behan, Justine; Kabajaasi, Olive; Derksen, Brooklyn; Sendegye, George; Kuugumikiriza; Komugisha, Clare; Sundararajan, Radhika; Jacob, Shevin T.; Kenya-Mugisha, Nathan; Wiens, Matthew O. — 2024-10-24 <strong>Background:</strong> Sepsis arises when the body’s response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program’s effect on post-discharge care. <br> <br><strong>Methods:</strong> We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. <br/> <br><strong>Findings:</strong> Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.<br/> <br><strong>Data Collection Methods:</strong> Facilitators of the same sex as the participants moderated the FGDs in the local language. Individual interviews with nurses were conducted by a social scientist in English. A focus group discussion guide and a semi-structured interview guide were used to provide structure and consistency to the discussion/interviews while allowing for novel concepts to be shared. Topics in the interview and FGD guides were developed by senior investigators who have expertise in the field of pediatric sepsis. The FDG guides focused on experiences at the admitting facility, experiences after discharge, processes involving referral for post-discharge clinical care, and barriers to post-discharge care. Interview guides focused on the experience of providing caregiver education and counselling, and reporting of which programmatic components worked well and did not work well. Nurse interviewees were also asked about their observations of the benefits and challenges of the program to the caregivers. Due to budget and logistical constraints, the FGD and interview guides were not pre-tested prior to use and no repeat interviews were done. FGDs and interviews were audio recorded and transcribed directly in English by a professional translator and then reviewed for accuracy and consistency. Using a thematic analysis approach, initial open coding of transcripts was done by two investigators. During analysis, data was organized using NVivo version 12.0 (QSR, Massachusetts, United States). After development of the coding framework and initial coding, themes were proposed, and discussed between three investigators who jointly agreed on the study themes and then confirmed full team agreement on the final themes. <br/> <br><strong>Ethics Declaration:</strong> Ethical approval was obtained from the the Makerere University School of Public Health, Research and Ethics Committee (SPH-REC # 691) and the Uganda National Council for Science and Technology (UNCST SS #5047). <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.
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Smart Triage: Clinical Data - QI
Borealis
Kissoon, Niranjan; Kasyaba, Ronald; Kenya-Mugisha, Nathan; Ansermino, J Mark; Opar, Bernard; Dumont, Guy; Komugisha, Clare; Agaba, Collins; Mwaka, Savio; Pillay, Yashodani; Wiens, Matthew O — 2024-11-20 This data is from the Smart Triage + QI: A digital triaging platform to improve quality of care for critically ill children study. Data collected for this study occurred from December 2021 to July 2023. <br> <br/><strong>Objective(s):</strong> This is a pre-post intervention study involving pediatric patients presenting to the study hospitals in seek of medical care for an acute illness. The purpose of this project was to implement Smart Triage + QI to improve the quality of care at four health care facilities in Uganda. The primary objective of the program is to enable healthcare workers to recognize the most urgent children more rapidly and allocate existing resources more efficiently. The second objective is to use the proactive processes of QI to identify and examine opportunities for ongoing improvement to strengthen the health system. The study involved two phases: (I) Baseline Period, and (II) Intervention Period. Phase II also involved a community sub-study at 1 site to identify key messaging for an appropriate methods for disseminating educational materials for VHTs and caregivers on Smart Triage. <br> <br /><strong>Data Description:</strong> Data was collected at the time of triage by trained study nurses using a custom-built mobile application. All data entered into the mobile application was stored an encrypted database. Data was uploaded directly from the mobile device to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). Outcomes were obtained from facility records or telephone follow-up at 7-10 days and the data was collected electronically. Starting in June 2022, outcomes were also collected via automated follow-up (SMS/WhatsApp) messages at one site. Time-specific outcomes were tracked using an RFID tagging system with study personnel as backup. <br> <br /><strong>Limitations:</strong> There is missing data and some variables were not collected at all sites. <br> <br /><strong>Ethics Declaration:</strong> This study was approved by the Makerere University Higher Degrees research and Ethics Committee (SPH-2021-41), the Uganda National Institute of Science and Technology (HS 1745ES). <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

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(Author: Kenya-Mugisha, Nathan)

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