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

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.

Development of a novel mobile application, HBB Prompt, with human factors and user-centred design for Helping Babies Breathe skills retention in Uganda

“…We used FGDs to better understand when different cognitive processes took place, influencing our strategies for knowledge and skills retention, a method supported by the applied cognitive task analysis [42]. This strategy has been successful in developing apps for various purposes in healthcare [25,43,44], including those in the maternal newborn health domain [29,[32][33][34]42].…”

“…Design processes with iterative prototyping have been successfully used to develop mobile apps for various purposes, such as supporting lifestyle interventions for cardiovascular health [25], clinical decision-making for osteoporosis treatment [26], and self-management for dementia patients [27]. Apps targeted towards newborn health [28][29][30][31][32][33][34] have been created and evaluated previously, some employing UCD, but none have informed their design by exploring the cognitive processes of learning newborn resuscitation skills. Understanding the underlying preferences, perceptions, facilitators and barriers that drive behaviours can help tailor the development of features and functions of apps [25,35,36].…”

Uso da mobile health pelo agente comunitário de saúde na assistência neonatal

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Refining clinical algorithms for a neonatal digital platform for low-income countries: a modified Delphi technique

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“…Community HCWs in rural Bangladesh were trained to use a mobile application for neonatal assessment and improved their clinical evaluations, the accuracy of their diagnoses, and their adherence to neonatal management guidelines. [7] Other attempts have been made to introduce health technologies, but most are not available when and where they are needed. [8]…”