Global Strategies develops and implements innovative technological solutions that help our partners overcome the challenges of their limited resource settings. We focus on simple and scalable technologies that allow healthcare providers to track their outcomes in real-time using cloud-based data collection software and analysis tools.
We help our partners establish baseline data in neonatal mortality rates and stillbirth rates. Additionally, we use technology to track inventory of critical supplies and predict stock needs over time.
We also work to bridge the gap between care delivery and data collection by developing software programs that facilitate care delivery while simultaneously collecting data that guides resource allocation.
Global Strategies developed a neonatal decision support tool, called NoviGuide that has begun field testing this year.
Despite recent progress in reducing deaths among children under age 5 years, a significant number of infants continue to die in the first month of life, exceeding 2.8 million worldwide in 2013. The highest rates of neonatal deaths occur in sub-Saharan Africa (SSA). Approximately 44% of all under-5 deaths in SSA occur in the neonatal period (first month of life), with about 75% of deaths occurring within the first week of life.
Simple neonatal care protocols, such as those described in the World Health Organization (WHO) Essential Newborn Care guidelines, can lead to significant improvements and form the core of current global efforts to reduce neonatal mortality. However, implementation of evidence-based protocols has been hampered by significant challenges: in-person training does not reliably lead to changes in workplace behavior, medical errors are common, changes in practice are lost quickly without reinforcement, and performance is difficult to monitor.
Our team has developed NoviGuide, a tablet-based training and decision-support tool, to optimize the hospital-based care of newborns by nurses in resource-limited countries.
In essence, NoviGuide translates WHO guidelines into case-specific clinical instructions that focus on
- respiratory support,
- glucose, fluid and feeding, and
- infection risk and management.
NoviGuide aims to address current barriers to neonatal care improvement by offering increased fidelity to guidelines, efficiency with streamlined decision support algorithms, accuracy with automatic medication and fluid calculations,reinforcement of skills learned in standard training, and monitoring using seamless cloud-based usage data uploads.
- NoviGuide is a real-time aid, designed for use by nurses as they care for babies
- NoviGuide provides continual training reinforcement through its use
- NoviGuide bridges the gap between care delivery and data collection
A Case Example
Currently, if a nurse is fortunate enough to receive extra training on the care of newborns, she will travel from her clinical site to a three to five day conference. There she will be trained in the established neonatal care protocols and perhaps practice a few scenarios on neonatal mannequins. Following the course, the nurse will return to her clinical site and translate her new knowledge into clinical practice change. The ability of the course organizers to verify that babies are being treated better as a result of the course is severely limited.
With NoviGuide, the neonatal care protocols are presented to any nurse taking care of a newborn at the point-of-care through guided and interactive questions. NoviGuide makes a nurses life easier by calculating weight-dependent neonatal dosages of common medications. NoviGuide then tracks as the nurses treat -- using anonymous data to survey disease prevalence and care quality across wide geographic areas 24/7. Health administrators can then monitor remotely the adherence and fidelity to evidenced-based neonatal care and target in-service trainings and interventions.
Human factors and acceptability/feasibility testing were conducted in Kwazulu-Natal, South Africa with Boston Children's Hospital. Nurses went through scripted clinical cases while being filmed and then participated in a dialogue about the experience and provided feedback. The software was then tested in three rural district hospitals. With that testing, nurses used the application when caring for patients and provided feedback on the alignment of the clinical recommendations and ease of use.
Global Strategies is excited to join the Preterm Birth Initiative at UCSF. As part of that effort, NoviGuide will be field-tested in Tororo, Uganda.