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Feasibility, acceptability and preliminary effectiveness of the Hospital to Home discharge and follow-up programme in
Beatrice Niyonshaba1, Daniel Kabugo1, Cornety Nakiganda1
1Adara Development Uganda, Luwero, Nakaseke District, Uganda.
Insights
The Hospital to Home (H2H) program in Uganda was feasible and acceptable for improving newborn care. While neurodevelopmental outcomes did not differ, the H2H program significantly increased vaccination and exclusive breastfeeding rates.
Area of Science:
- Global Health
- Neonatal Medicine
- Public Health Interventions
Background:
- High mortality rates among premature and sick newborns in low- and middle-income countries necessitate innovative interventions.
- Over 60% of premature infants are born in Africa or South Asia, facing risks of death, poor growth, and developmental impairments.
- The Hospital to Home (H2H) program was developed to address these challenges in rural Uganda.
Purpose of the Study:
- To evaluate the feasibility, acceptability, and preliminary effectiveness of the H2H discharge and follow-up program.
- To assess the impact of H2H on neurodevelopmental, growth, nutritional, and vaccination outcomes for small and sick newborns.
- To gather qualitative insights from caregivers and healthcare workers regarding the H2H program.
Main Methods:
- A comparative study design involving a historical-comparison cohort and an intervention cohort of high-risk neonates in rural Uganda.
- The intervention cohort received the H2H program, a comprehensive package of hospital and community-based interventions.
- Outcomes at 6 months corrected age were compared, supplemented by qualitative interviews.
Main Results:
- The H2H program was found to be feasible and acceptable to caregivers and healthcare providers.
- No statistically significant difference in 6-month corrected neurodevelopmental outcomes was observed between the cohorts.
- Significant improvements were noted in vaccination completion rates (88.5% vs 76.9%) and exclusive breastfeeding rates (42% vs 6.6%) in the intervention group.
Conclusions:
- The Hospital to Home (H2H) program is a feasible and acceptable intervention for supporting small and sick newborns in rural Uganda.
- The program demonstrated positive impacts on vaccination and exclusive breastfeeding rates.
- Further research is recommended to investigate the long-term effectiveness of the H2H program within government health services.
Introduction:
Over 60% of premature infants are born in Africa or South Asia. Infants born early, small or who become sick after birth have a higher risk of death, poor growth and developmental impairments. Innovative interventions tailored for low- and middle-income countries are essential to help these newborns survive and develop optimally. This study evaluated the feasibility, acceptability and preliminary effectiveness of Hospital to Home (H2H), a discharge and follow-up programme for small and sick newborns in rural Uganda.
Methods:
We compared two cohorts of high-risk hospitalised neonates in Uganda: a historical-comparison cohort receiving standard facility-based care and an intervention cohort that received the H2H programme, a hospital and community spanning package of interventions designed to improve neurodevelopmental outcomes. We compared 6-month corrected neurodevelopmental, growth, nutritional and vaccination outcomes between the cohorts complemented by qualitative interviews of caregivers, community health workers and health facility staff.
Results:
We recruited 191 participants: 91 historical-comparison cohort (born between July and September 2018), and 100 intervention cohort (born July 2019 to February 2020). No statistically significant difference was seen in neurodevelopmental outcomes (adjusted OR 0.68; 95% CI: 0.32 to 1.46). Improved vaccination completion (88.5% intervention vs 76.9% comparison, p=0.041), and exclusive breastfeeding rates (42% vs 6.6%, p<0.001) were seen. Caregivers and healthcare workers reported the intervention to be acceptable and feasible in this rural Ugandan setting.
Conclusion:
The H2H programme was feasible and acceptable to caregivers and healthcare providers. Improved vaccination and exclusive breastfeeding rates were seen in the intervention group when compared with a historical comparison cohort in this rural Ugandan setting. Further investigation on the short and long-term effectiveness of the H2H programme in a government health services setting is warranted.
Trial Registration Number:
ISRCTN51636372.
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