Implementation Outcomes Assessment of a Digital Clinical Support Tool for Intrapartum Care in Rural Kenya: Observational Analysis.

BACKGROUND: iDeliver, a digital clinical support system for maternal and neonatal care, was developed to support quality of care improvements in Kenya. OBJECTIVE: Taking an implementation research approach, we evaluated the adoption and fidelity of iDeliver over time and assessed the feasibility of its use to provide routine Ministry of Health (MOH) reports. METHODS: We analyzed routinely collected data from iDeliver, which was implemented at the Transmara West Sub-County Hospital from December 2018 to September 2020. To evaluate its adoption, we assessed the proportion of actual facility deliveries that was recorded in iDeliver over time. We evaluated the fidelity of iDeliver use by studying the completeness of data entry by care providers during each stage of the labor and delivery workflow and whether the use reflected iDeliver's envisioned function. We also examined the data completeness of the maternal and neonatal indicators prioritized by the Kenya MOH. RESULTS: A total of 1164 deliveries were registered in iDeliver, capturing 45.31% (1164/2569) of the facility's deliveries over 22 months. This uptake of registration improved significantly over time by 6.7% (SE 2.1) on average in each quarter-year (P=.005), from 9.6% (15/157) in the fourth quarter of 2018 to 64% (235/367) in the third quarter of 2020. Across iDeliver's workflow, the overall completion rate of all variables improved significantly by 2.9% (SE 0.4) on average in each quarter-year (P<.001), from 22.25% (257/1155) in the fourth quarter of 2018 to 49.21% (8905/18,095) in the third quarter of 2020. Data completion was highest for the discharge-labor summary stage (16,796/23,280, 72.15%) and lowest for the labor signs stage (848/5820, 14.57%). The completion rate of the key MOH indicators also improved significantly by 4.6% (SE 0.5) on average in each quarter-year (P<.001), from 27.1% (69/255) in the fourth quarter of 2018 to 83.75% (3346/3995) in the third quarter of 2020. CONCLUSIONS: iDeliver's adoption and data completeness improved significantly over time. The assessment of iDeliver' use fidelity suggested that some features were more easily used because providers had time to enter data; however, there was low use during active childbirth, which is when providers are necessarily engaged with the woman and newborn. These insights on the adoption and fidelity of iDeliver use prompted the team to adapt the application to reflect the users' culture of use and further improve the implementation of iDeliver.

Insights from community case management data in six sub-Saharan African countries.

There is strong research evidence that community case management (CCM) programs can significantly reduce mortality. There is less evidence, however, on how to implement CCM effectively either from research or regular program data. We analyzed monitoring data from CCM programs supported by the International Rescue Committee (IRC), covering over 2 million treatments provided from 2004 to 2011 in six countries by 12,181 community health workers (CHWs). Our analysis yielded several findings of direct relevance to planners and managers. CCM programs seem to increase access to treatment, although diarrhea coverage remains low. In one country, the size of the catchment area was correlated with use, and increased supervision was temporally and strongly associated with improved quality. Planners should use routine data to guide CCM program planning. Programs should treat all three conditions from the outset. Other priorities should include use of diarrhea treatment and insurance of adequate supervision.

Reported wearing compliance of ready-made spectacles at 6 and 12 months.

PURPOSE: Ready-made spectacles are often used in low-resource environments, but to date, there has been little evaluation of the continued use of these spectacles over time. The aim of this study was to assess wearing compliance of those who received ready-made spectacles. METHODS: The International Rescue Committee trains refugee health workers to provide simple refractive services and dispense ready-made spherical lenses to residents of refugee camps on the Thailand-Burma border. We conducted follow-up interviews in five camps among all eligible and available spectacle recipients who had been examined either 6 (n = 230) or 12 months earlier (n = 187). Interviewers asked about continued use of spectacles and, among those who had discontinued spectacle use, asked the reason for discontinuing. RESULTS: Reported spectacle wear was significantly higher at 6 months compared with 12 months (73.9 vs. 55.6%, p < 0.001). At 6 months, wearing compliance was significantly higher for females than males (79.2 vs. 67.6%, p = 0.033), but gender differences in wearing compliance were not seen at 12 months, and no differences were found between 10-year age groups at 6 or 12 months. Wearing compliance rates among recipients seen at different camps were significantly different at both 6 months (range, 58.1 to 87.5%, p = 0.005) and 12 months (range, 32 to 85.7%, p = 0.002). The top reason given for discontinued spectacle wear was broken frames, followed by vision-related complaints, scratched lenses, lost spectacles, and appearance. CONCLUSIONS: Our findings suggest that spectacle wearing compliance studies will not be comparable unless a standard time frame is used to assess compliance. We found assessing self-reported compliance to be a useful tool in guiding our program. Understanding the reasons for non-compliance will help guide corrective action and planning of interventions designed to increase wearing rates.