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Feasibility of Post-Operative Telehealth for Pediatric Surgical Patients in Malawi-A Mixed Methods Analysis
Madhushree Zope1, Seraiah Mdala2, Wiseman Phiri2
1Department of General Surgery, University of Alabama at Birmingham General Surgery Birmingham, Birmingham, Alabama, USA.
Insights
Post-operative follow-up via phone calls is feasible in Malawi, showing high reachability and acceptability. This pilot study supports expanding telehealth services to improve pediatric surgical care quality.
Area of Science:
- Global Surgery
- Health Services Research
- Telehealth
Background:
- Pediatric surgical capacity in Malawi has grown, yet post-operative outcome data for common conditions in low-resource settings remain scarce.
- Limited understanding exists regarding the effectiveness of post-operative follow-up strategies in resource-constrained environments.
Purpose of the Study:
- To assess the feasibility of post-operative follow-up for pediatric surgical patients in Malawi using telephone calls.
- To evaluate patient reachability and acceptability of telephone follow-up protocols.
Main Methods:
- Guardians of pediatric patients undergoing general surgery at Kamuzu Central Hospital were recruited.
- Telephone follow-up questionnaires and Acceptability of Intervention Measure (AIM) scores were administered 30 days post-operation.
- Semi-structured interviews were conducted to explore participant experiences and factors influencing telephone follow-up.
Main Results:
- High phone access (94.5%) and reachability (69.2%) were observed among eligible families.
- Having a secondary phone increased the odds of reachability (OR=2.0, p=0.04).
- Key factors affecting follow-up included phone ownership, network access, phone charge, and community influence.
Conclusions:
- Telephone-based post-operative follow-up is a feasible strategy in Malawi, demonstrating high patient reachability and acceptability.
- The findings support the scale-up of telehealth follow-up to enhance the quality of pediatric surgical care in Malawi.
Background:
Pediatric operative volumes in Malawi have increased over the past decade due to an increase in the pediatric surgical workforce and improved infrastructure. Despite growth in surgical capacity, limited data exist regarding post-operative outcomes for common surgical diseases in low-resource settings.
Methods:
Guardians of patients < 18 years old undergoing general surgery operations at Kamuzu Central Hospital (KCH) were recruited. Two telephone call attempts 30-day after the operation were made to administer a follow-up questionnaire and an Acceptability of Intervention Measure (AIM) score. Guardians were then purposively sampled for semi-structured interviews to assess participant experiences in the telephone follow-up protocol. Feasibility of telehealth follow up, defined here as reachability and acceptability, and guardian perceived factors affecting reachability were analyzed.
Results:
Of 327 families approached for recruitment, 309 (94.5%) had access to a phone. After accounting for clinical events, 292 were eligible for a 30-day phone call. The majority of patients were male (70.6%) and the median age was 2 years old (IQR: 0.02-14). Overall, 69.2% (n = 202) were reached via phone call. Participants with secondary phones had increased odds of reachability (OR = 2.0, p = 0.04) compared to those with only a primary phone. The mean AIM score of the reached group was 18.3 (SD: 2.6). Among the interviewees-phone ownership, cellular network access, phone charge, and community influence were identified as key factors affecting participation in telephone follow-up.
Conclusions:
Post-operative follow-up via phone call is feasible in Malawi as evidenced by high patient reachability and acceptability. The results of this pilot study support scaling up implementation of telehealth follow-up in Malawi and utilizing the resulting post-operative metrics to guide quality improvement of surgical care.
