High-risk newborns Neonatal Diseases
Conditions
Interventions
The Hospital to Home programme, developed and piloted jointly by Adara Group and Kiwoko Hospital, is designed to improve both the care of sick and premature babies in the hospital as well as provide f
training and education for staff in supporting mothers to breastfeed their baby and in providing care that supports optimal brain development
an education programme for the parents in the provision of at-home care for their high-risk babies - including the recognition of danger signs.
The second part of the package takes place in the commu
Sponsors
Adara Development
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Growth, neurodevelopmental assessment and caregiver-child bonding: 1.1. Born in a three-month window (July -Sept 2018 for historical comparison cohort and July-Sept 2020 for intervention cohort) 1.2. Discharged alive from the KH neonatal unit 1.3. 6 months adjusted age at time of assessment (infant may be one week younger or two weeks older than 6 months adjusted age at time of assessment) 1.4. Gestational age available 1.5. Living in 3 surrounding districts (Luweero, Nakaseke, Nakasongola) 1.6. Obtained informed written consent by guardian 2. Parents/caregiver interviews before H2H implementation: those parents/caregivers who will not receive the intervention and are a part of the historical control 3. Parents/caregiver interviews during/after H2H implementation: those parents/caregivers who have received the intervention and are part of the intervention group 4. Clinicians/nurses: those working in Kiwoko Neonatal Intensive Care Unit who have provided written consent 5. Village Health Teams: those who received Adara VHT training and are mobilized for H2H project and who have provided written consent
Exclusion criteria
Exclusion criteria: Does not meet inclusion criteria
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Feasibility, acceptability, scalability of H2H package: 1. Participant recruitment rate will be recorded as the number of caregivers/parents who consent to participate in the study by the end of May 2019 (caregivers in control cohort) and May 2020 (caregivers in intervention cohort) 2. Number of parents/caregivers discharged following the discharge checklist will be measured as the number of caregivers recorded by KH discharge coordinators by the end of September 2020 3. Number/proportion of neonatal unit in-hospital follow-up appointment attendance will be measured as the number recorded in follow up clinic’s registry by the end of September 2020 4. Number/proportion of babies followed up by VHTs will be measured as the number recorded by VHTs in VHT register by the end of September 2020 5. Number of VHTs attending monthly meetings and their knowledge retention will be measured as number/proportion recorded during those meetings, which will be continued until the end of September 2020 6. VHTs’ performance/skill in delivering at-home newborn care will be measured by observing their records of a baby’s assessment (e.g. weighing, temperature reading, weight classification, neonatal unit follow up/referral need etc) against assessment of the same baby by an experienced midwife 7. Barriers and challenges experienced in receiving health care, follow up, and comments about the acceptance of the neonatal unit and VHT care will be examined by views and experience of caregivers and VHTs in IDIs to be conducted by the end of September 2020 8. The operational feasibility of continuing H2H implementation and potential to sustain the intervention by KH will be assessed by the views and experience of KH neonatal unit staff, VHTs and Adara staff in their IDIs to be conducted by the end of September 2020 9. The operational feasibility of recruiting skilled village health teams / community healthcare workers will be assessed by the views and experiences of KH neonatal unit staff and | — |
Secondary
| Measure | Time frame |
|---|---|
| Early effectiveness on growth and neurodevelopmental outcomes of high-risk newborns: 1. Anthropometrics (weight, height, head circumference, upper arm circumference and anaemia) will be measured using infant weighing scales, length board, MUAC tape, Paediatric circumference tape (head circumference), and HemoCue (anaemia) at six months adjusted age. Assessment will be completed by the end of May 2019 for the control cohort and May 2020 for the intervention cohort 2. Neurodevelopmental outcomes will be measured using Griffith Mental Development Scales questionnaire at six months adjusted age. Assessment will be done by the end of May 2019 for the control cohort and May 2020 for the intervention cohort 3. Mother-child bonding will be measured using Maternal Infant Responsiveness Instrument at 6 months adjusted age. Assessment will be done by the end of May 2019 for the control cohort and May 2020 for the intervention cohort 4. Exclusive breastfeeding rate at six months adjusted age will be measured as number recorded in the History Form. Assessment will be done by the end of May 2019 for the control cohort and May 2020 for the intervention cohort | — |
Countries
Uganda
Outcome results
None listed