Effectiveness of WhatsApp based debunking reminders on follow-up visit attendance for individuals with hypertension: a randomized controlled trial in India.

BACKGROUND: Individuals with high blood pressure in India often miss essential follow-up visits. Missed visits contribute to gaps across the hypertension care continuum and preventable cardiovascular disease. Widespread misconceptions around hypertension care and treatment may contribute to low follow-up attendance rates, but to date, there is limited evidence of the effect of interventions to debunk such misconceptions on health-seeking behavior. We conducted a randomized controlled trial to measure whether combining information debunking commonly-held misconceptions with a standard reminder reduces missed follow-up visits among individuals with high blood pressure and investigated whether any observed effect was moderated through belief change. METHODS: We recruited 388 patients with uncontrolled blood pressure from the outpatient wards of two public sub-district hospitals in Punjab, India. Participants randomly assigned to the intervention arm received two WhatsApp messages, sent 3 and 1 days before their physician-requested follow-up visit. The WhatsApp message began with a standard reminder, reminding participants of their upcoming follow-up visit and its purpose. Following the standard reminder, we included brief debunking statements aimed at acknowledging and correcting common misconceptions and misbeliefs about hypertension care seeking and treatment. Participants in the control group received usual care and did not receive any messages. RESULTS: We did not find evidence that the enhanced WhatsApp reminders improved follow-up visit attendance (Main effect: 2.2 percentage points, p-value = 0.603), which remained low across both treatment (21.8%, 95% CI: 15.7%, 27.9%) and control groups (19.6%, 95% CI: 14.2%, 25.0%). Participants had widespread misconceptions about hypertension care but our debunking messages did not successfully correct these beliefs (p-value = 0.187). CONCLUSIONS: This study re-affirms the challenge of continuity of care for chronic diseases in India and suggests that simple phone-based health communication methods may not suffice for changing prevalent misconceptions and improving health-seeking behavior. TRIAL REGISTRATION: The trial began on July 18th. We registered the trial on July 18th (before recruitment began), including the main outcomes, on the German Clinical Trial Register [Identifier: DRKS00029712] and published a pre-analysis plan in the Open Science Framework [osf.io/67g35].

Can training over phone calls help improve outcomes for COVID-19 positive patients under home isolation? An analysis of the COVID-19 Care Companion Program in Punjab, India.

Background: Phone-supported recovery of COVID-19 patients in home isolation could be an effective way of addressing COVID-19 in contexts with limited resources. The COVID-19 Care Companion Program (CCP) is one such intervention, designed to support patients and their caregivers in remote, evidence-based management of COVID-19 symptoms. Objective: To estimate the effect of providing phone-based training to COVID-19 patients and their caregivers on the likelihood of hospitalizations and mortality. Methods: A pragmatic randomized trial was conducted to assess the effect of a novel phone-based training program on COVID-19 home-isolated patient outcomes. The analysis compared the outcomes of death and hospitalizations in the teletraining intervention group (CCP) to those receiving standard of care (SoC). Results: Logistic regression models adjusted for age, gender, education, occupation, and poverty, as measured by family possession of Below Poverty Line (BPL) card, were used to look at the effect of intervention on hospitalization and mortality. While the CCP intervention had no effect on 21-day mortality (OR 0.64; 95% CI, 0.19 to 2.12), it was associated with a 48% reduction in 21-day hospitalization (OR 0.52; 95% CI, 0.31 to 0.90). Conclusion: COVID-19 CCP teletraining intervention reduced the rate of hospitalization, potentially reducing the burden on hospitals.

Qualitative assessment of family caregiver-centered neonatal education program in Karnataka, India.

Globally 2.5 million newborns die every year before they reach the age of one month; the majority of these deaths occur in low- and middle-income countries. Among other factors, inadequate knowledge and skills to take care of newborns contribute to these deaths. To fill this gap, training patients and family members on the behaviors needed to improve essential newborn care practices at home is a promising opportunity. One program that aims to do this is the Care Companion Program (CCP) which provides in-hospital, skills-based training on care of mothers and newborns to families. This study uses semi-structured interviews to understand how and why knowledge and behaviors of maternal and newborn care behaviors change (or don't change) as a result of CCP sessions and participants' perception of the impact of CCP on change. Interviews focused on knowledge and behaviors around key neonatal and newborn topics and health seeking behaviors for health complications. Forty-two in-depth interviews were conducted among families with recently-delivered babies at their homes from four districts in Karnataka, India. Respondents have a positive perception about CCP, found training useful and appreciated other family members presence during the training. CCP increased knowledge and awareness and provided critical details to key behaviors like breastfeeding. Respondents were more likely to be receptive toward details on already known topics, like hand washing before touching the baby. Awareness increased on newly learned behaviors, like skin-to-skin care, which don't conflict with cultural norms. The CCP did not influence nonrestrictive maternal diet as much, which cultural norms heavily influence. In-hospital family caregiver education programs, like CCP, can positively influence key neonatal behaviors by imparting knowledge and key skills. However, the effect is not universal across health behaviors.

Improving neonatal health with family-centered, early postnatal care: A quasi-experimental study in India.

Despite the global decline, neonatal mortality rates (NMR) remain high in India. Family members are often responsible for the postpartum care of neonates and mothers. Yet, low health literacy and varied beliefs can lead to poor health outcomes. Postpartum education for family caregivers, may improve the adoption of evidence-based neonatal care and health outcomes. The Care Companion Program (CCP) is a hospital-based, pre-discharge health training session where nurses teach key healthy behaviors to mothers and family members, including skills and an opportunity to practice them in the hospital. We conducted a quasi-experimental study to assess the effect of the CCP sessions on mortality outcomes among families seeking care in 28 public tertiary facilities across 4 Indian states. Neonatal mortality outcomes were reported post-discharge, collected via phone surveys at four weeks postpartum, between October 2018 to February 2020. Risk ratios (RR), adjusting for hospital-level clustering, were calculated by comparing mortality rates before and after CCP implementation. A total of 46,428 families participated in the pre-intervention group and 87,305 in the post-intervention group; 76% of families completed the phone survey. Among the 33,599 newborns born before the CCP implementation, there were 1386 deaths (NMR: 41.3 deaths per 1000 live births). After the intervention began, there were 2021 deaths out of 60,078 newborns born (crude NMR: 33.6 deaths per 1000 live births, RR = 0.82, 95% CI: 0.76, 0.87; cluster-adjusted RR = 0.82, 95% CI: 0.71, 0.94). There may be a substantial benefit to family-centered education in the early postnatal period to reduce neonatal mortality.

Supporting Immunization Uptake during a Pandemic, Using Remote Phone Call Intervention among Babies Discharged from a Special Neonatal Care Unit (SNCU) in South India.

COVID-19 has impacted children's immunization rates, putting the lives of children at risk. The present study assesses the impact of phone-call counseling, on immunization uptake during the pandemic. Families of babies discharged from the SNCUs in six government centers in three South Indian states were recruited. Calls were made 10 days after the immunization due date. Missed vaccinees were counseled and followed up on 7 and 15 days. Of 2313 contacted, 2097 completed the survey. Respondents were mostly mothers (88.2%), poor (67.5%), and had secondary level education (37.4%). Vaccinations were missed due to the baby's poor health (64.1%), COVID-19 related concerns (32.6%), and lack of awareness (16.8%). At the end of the intervention, the immunization uptake increased from 65.2% to 88.2%. Phone-call intervention can safely support immunization and lower the burden on health workers.

Impact of family-centred postnatal training on maternal and neonatal health and care practices in district hospitals in two states in India: a pre-post study.

BACKGROUND AND OBJECTIVES: The Care Companion Program (CCP) is an in-hospital multitopic skill-based training programme provided to families to improve postdischarge maternal and neonatal health. The states of Punjab and Karnataka in India piloted the programme in 12 district hospitals in July 2017, and no study to date has evaluated its impact. METHODS: We compared telephonically self-reported maternal and neonatal care practices and health outcomes before and after the launch of the CCP programme in 11 facilities. Families in the preintervention group delivered between May to June 2017 (N=1474) while those in the intervention group delivered between August and October 2017 (N=3510). Programme effects were expressed as adjusted risk ratios obtained from logistic regression models. RESULTS: At 2-week postdelivery, the practice of dry cord care improved by 4% (RR=1.04, 95% CI 1.02 to 1.06) and skin-to-skin care by 78% (RR=1.78, 95% CI 1.37 to 2.27) in the postintervention group as compared with preintervention group. Furthermore, newborn complications reduced by 16% (RR=0.84, 95% CI 0.76 to 0.91), mother complications by 12% (RR=0.88, 95% CI 0.79 to 0.97) and newborn readmissions by 56% (RR=0.44, 95% CI 0.31 to 0.61). Outpatient visits increased by 27% (RR=1.27, 95% CI 1.10 to 1.46). However, the practice of exclusive breastfeeding, unrestricted maternal diet, hand-hygiene and being instructed on warning signs were not statistically different. CONCLUSION: Postnatal care should incorporate predischarge training of families. Our findings demonstrate that it is possible to improve maternal and neonatal care practices and outcomes through a family-centered programme integrated into public health facilities in low and middle-income countries.

Just-in-time postnatal education programees to improve newborn care practices: needs and opportunities in low-resource settings.

Worldwide, many newborns die in the first month of life, with most deaths happening in low/middle-income countries (LMICs). Families' use of evidence-based newborn care practices in the home and timely care-seeking for illness can save newborn lives. Postnatal education is an important investment to improve families' use of evidence-based newborn care practices, yet there are gaps in the literature on postnatal education programees that have been evaluated to date. Recent findings from a 13 000+ person survey in 3 states in India show opportunities for improvement in postnatal education for mothers and families and their use of newborn care practices in the home. Our survey data and the literature suggest the need to incorporate the following strategies into future postnatal education programming: implement structured predischarge education with postdischarge reinforcement, using a multipronged teaching approach to reach whole families with education on multiple newborn care practices. Researchers need to conduct robust evaluation on postnatal education models incorporating these programee elements in the LMIC context, as well as explore whether this type of education model can work for other health areas that are critical for families to survive and thrive.

A Novel, Low-Cost, Wide-Field, Infant Retinal Camera, "Neo": Technical and Safety Report for the Use on Premature Infants.

PURPOSE: To report the technical aspects, systemic, and ocular safety of a novel, low-cost, wide-field, infant retinal camera for use on premature infants. METHODS: The device, the "3nethra Neo" (Neo) is a 120° portable, contact, wide-field, unibody camera, with a CMOS sensor (2040 × 2040 resolution) and a warm light-emitting diode (LED) illumination source. The Neo was used to image 140 awake, preterm infants between postmenstrual age (PMA) of 28 to 37 weeks, undergoing retinopathy of prematurity (ROP) screening. Baseline, 'during procedure', at 5 minutes, and for 60 minutes postprocedure, readings of oxygen saturation and heart rate were recorded. The device design, optics, illumination, and software specifications were compared with the RetCam 3. RESULTS: Study defined bradycardia (9 infants, 6.4%), tachycardia (3 infants, 2.1%), and hypoxia (2 infants, 1.4%) were observed but there were no clinically significant systemic changes that required intervention during or following any of the study time intervals. There was a transient increase in heart rate by 9.68 (7.53-11.83; P < 0.0001) and marginal decrease in oxygen saturation (-1.94 [-1.60 to -2.28], P < 0.0001), which started to return to baseline 5 minutes after the procedure. Transient redness was seen in two eyes (0.7%) of two infants. No other ocular adverse effects were observed. CONCLUSIONS: The Neo is easy to use in preterm infants and being compact was readily portable. There were no significant ocular or systemic adverse effects, potentially allowing it to be a viable low-cost device for ROP screening in low resource settings. TRANSLATIONAL RELEVANCE: The camera provides a safe and affordable alternative to image the retina of infants by using novel illumination and lens mechanics and has the potential of worldwide acceptance.

Attracting doctors to rural areas: a case study of the post-graduate seat reservation scheme in andhra pradesh.

BACKGROUND: Attracting doctors to rural posts is an ongoing challenge for health departments across different states in India. One strategy adopted by several states to make rural service attractive for medical graduates is to reserve post-graduate (PG) seats in medical colleges for doctors serving in the public sector. OBJECTIVE: This study examines the PG reservation scheme in Andhra Pradesh to understand its role in improving rural recruitment of doctors and specialists, the challenges faced by the scheme and how it can be strengthened. MATERIALS AND METHODS: Qualitative case study methodology was adopted in which a variety of stakeholders such as government officials, health systems managers and serving Medical Officers were interviewed. This was supplemented with quantitative data on the scheme obtained from the Health, Medical and Family Welfare Department in Andhra Pradesh. RESULTS: The PG reservation scheme appears to have been one of the factors responsible in attracting doctors to the public sector and to rural posts, with a reduction in vacancies at both the Primary Health Centre and Community Health Centre levels. Expectedly, in-service candidates have a better chance of getting a PG seat than general candidates. However, problems such as the mismatch of the demand and supply of certain types of specialist doctors, poor academic performance of in-service candidates as well as quality of services and enforcement of the post-PG bond need to be resolved. CONCLUSION: The PG reservation scheme is a powerful incentive to attract doctors to rural areas. However, better monitoring of service quality, strategically aligning PG training through the scheme with the demand for specialists as well as stricter enforcement of the financial bond are required to improve the scheme's effectiveness.