Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App and Dashboard: A 1-Year Digital Perinatal Outcome Audit

Abstract

Introduction: Understanding the extent and cause of high neonatal deaths rates in Sub-Saharan Africa is a challenge, especially in the presence of poor-quality and inaccurate data. The NeoTree digital data capture and quality improvement system has been live at Kamuzu Central Hospital, Neonatal Unit, Malawi, since April 2019.Objective: To describe patterns of admissions and outcomes in babies admitted to a Malawian neonatal unit over a 1-year period via a prototype data dashboard.Methods: Data were collected prospectively at the point of care, using the NeoTree app, which includes digital admission and outcome forms containing embedded clinical decision and management support and education in newborn care according to evidence-based guidelines. Data were exported and visualised using Microsoft Power BI. Descriptive and inferential analysis statistics were executed using R.Results: Data collected via NeoTree were 100% for all mandatory fields and, on average, 96% complete across all fields. Coverage of admissions, discharges, and deaths was 97, 99, and 91%, respectively, when compared with the ward logbook. A total of 2,732 neonates were admitted and 2,413 (88.3%) had an electronic outcome recorded: 1,899 (78.7%) were discharged alive, 12 (0.5%) were referred to another hospital, 10 (0.4%) absconded, and 492 (20%) babies died. The overall case fatality rate (CFR) was 204/1,000 admissions. Babies who were premature, low birth weight, out born, or hypothermic on admission, and had significantly higher CFR. Lead causes of death were prematurity with respiratory distress (n = 252, 51%), neonatal sepsis (n = 116, 23%), and neonatal encephalopathy (n = 80, 16%). The most common perceived modifiable factors in death were inadequate monitoring of vital signs and suboptimal management of sepsis. Two hundred and two (8.1%) neonates were HIV exposed, of whom a third [59 (29.2%)] did not receive prophylactic nevirapine, hence vulnerable to vertical infection.Conclusion: A digital data capture and quality improvement system was successfully deployed in a low resource neonatal unit with high (1 in 5) mortality rates providing and visualising reliable, timely, and complete data describing patterns, risk factors, and modifiable causes of newborn mortality. Key targets for quality improvement were identified. Future research will explore the impact of the NeoTree on quality of care and newborn survival.

Development and implementation experience of a learning healthcare system for facility based newborn care in low resource settings: The Neotree

“…The second dashboard is a slide-deck of monthly data available for presentation at local morbidity and mortality meetings. 41 A third targeted QI screen for improving key clinical indicators (eg, admission hypothermia) has been prototyped and piloted pending implementation in the future. 38 The automated delivery of morbidity mortality data to local multi-disciplinary teams is crucial for clinical F I G U R E 3 Data dashboard development, Kamuzu Central Hospital, Malawi: Moves units from hand-drawn, time consuming, unreliable and unclear data charts to clear, dynamic digital displays of meaningful data insights and driving impactful interventions (eg, hypothermia highlighted in lower right dashboard) 38 decision-making, resource management, and the monitoring of quality care and standards.…”

“…The first dashboard displays real‐time reports on a screen display in neonatal wards visualising key data (eg, admission and mortality rates). The second dashboard is a slide‐deck of monthly data available for presentation at local morbidity and mortality meetings 41 . A third targeted QI screen for improving key clinical indicators (eg, admission hypothermia) has been prototyped and piloted pending implementation in the future 38 .…”

“…Further usability‐focused development o was conducted following implementation in Kamuzu Central Hospital, in Lilongwe, Malawi (annual delivery rate ~ 4500) to create Neotree‐beta MVP‐2 38,41,48 . A focus of this work was the evaluated co‐development of a dashboard prototype as an electronic data feedback mechanism 48 .…”

“…The second dashboard is a slide‐deck of monthly data available for presentation at local morbidity and mortality meetings. 41 A third targeted QI screen for improving key clinical indicators (eg, admission hypothermia) has been prototyped and piloted pending implementation in the future. 38 The automated delivery of morbidity mortality data to local multi‐disciplinary teams is crucial for clinical decision‐making, resource management, and the monitoring of quality care and standards.…”

Usability-Focused Development and Usage of NeoTree-Beta, an App for Newborn Care in a Low-Resource Neonatal Unit, Malawi

“…Prior to being implemented in Malawi and Zimbabwe central hospitals ( 19 , 22 ), the NeoTree app was piloted in Zomba Central Hospital (ZCH), Malawi ( 20 ). This 1-month pilot included some preliminary usability testing which resulted in early adjustments to the app and produced the beta-app, “Minimum Viable Product 1” (MVP1), the most basic working version that can be safely launched and tested ( 23 ).…”