Clinical decision making in basic emergency obstetric and newborn care among nurses and midwives: the role of the safe delivery mhealth application_pre-post-intervention study (research protocol)

ABSTRACT

Most maternal and newborn deaths in low-income countries, including Rwanda, are attributable to preventable causes. Timely access to Basic Emergency Obstetric and Newborn Care (BEmONC) guidelines to support clinical decisions could lead to better obstetric care thus reduction of maternal and newborn deaths. Besides, innovative methods such as the usage and reference to healthcare guidelines using mobile devices (mhealth) may support clinical decision making. However, there is little evidence about mhealth that focuses on the clinical decision support process. This proposal aims to investigate the effect of the Safe Delivery mhealth Application(SDA) on nurses’ and midwives’ clinical decision making, so as to inform mhealth interventions for work in specific contexts. The study adopts a quasi-experimental design. Convergent parallel mixed – methods will be used to collect, analyze and interpret data. A pre-intervention assessment of the BEmONC outcomes: Apgar score and PPH progressions, and related knowledge, skills, and perceptions of nurses and midwives will be conducted. The intervention will take place in two district hospitals in Rwanda and entails the implementation of the SDA for six months. Six months’ post-intervention, the effect of the SDA on BEmONC outcomes and the nurses’ and midwives’ knowledge and skills will be evaluated.

KEYWORDS:

• BEmONC
• mhealth
• safe delivery application
• Rwanda

Abbreviations

BEmONC	=	Basic Emergency Obstetric and Newborn Care
mhealth	=	Mobile Health
SDA	=	Safe Delivery mhealth Application
PPH	=	Post-Partum Hemorrhage
NR	=	Neonatal Resuscitation
MNCH	=	Maternal Newborn and Child Health
WHO	=	World Health Organisation
UNICEF	=	United Nations International Children’s Emergency Fund
UNFPA	=	United Nations Population Fund
LMICs	=	Low- and middle-income countries
ICT	=	Information, communication, technology
SAQs	=	Self-Administered questionnaires
FGD	=	Focus Group Discussion
KII	=	Key Informant Interview

Acknowledgments

We would like to thank the Consortium for Advanced Research and Training (CARTA), The Ministry of Health, Rwanda and The Maternity Foundation.

Authors’ contributions

AN, DNC, MN and LI were involved in the conception and design of the study. AN drafted the manuscript. DNC, MN, and LI reviewed the manuscript. All authors read and approved the final manuscript.

Availability of data and materials

This article is a research proposal. The dataset generated for some of the phases of the study has not been analysed but will be made available from the corresponding author on reasonable request.

Consent for publication

Not applicable.

Disclosure of interest

The authors report no conflict of interest.

Ethics approval and consent to participate

This study has been approved by the Human Research Ethics Committee of the University of the Witwatersrand (M190258) and the University of Rwanda, College of Medicine and Health Sciences’ Institutional Review Board (No.377/CMHS IRB/2018). Permission has been granted by the hospitals. Written, informed consent will be obtained from all the participants.

Additional information

Funding

This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No–B 8606.R02), Sida (Grant No:54100113), the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z) and Deutscher Akademischer Austauschdienst (DAAD). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the Fellow”. The funding body/bodies played no role in the design of the study and data collection process, analysis, interpretation of data and in writing the manuscript;Wellcome Trust [Grant No--B 8606.R02];