Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural Rwanda
Abstract Background Caesarean sections account for roughly one third of all surgical procedures performed in low-income countries. Due to lack of standardised post-discharge follow-up protocols and practices, most of available data are extracted from clinical charts during hospitalization and are th...
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-022-08137-5 |
| _version_ | 1828777403654078464 |
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| author | Theoneste Nkurunziza Robert Riviello Frederick Kateera Edison Nihiwacu Jonathan Nkurunziza Magdalena Gruendl Stefanie J. Klug Bethany Hedt-Gauthier |
| author_facet | Theoneste Nkurunziza Robert Riviello Frederick Kateera Edison Nihiwacu Jonathan Nkurunziza Magdalena Gruendl Stefanie J. Klug Bethany Hedt-Gauthier |
| author_sort | Theoneste Nkurunziza |
| collection | DOAJ |
| description | Abstract Background Caesarean sections account for roughly one third of all surgical procedures performed in low-income countries. Due to lack of standardised post-discharge follow-up protocols and practices, most of available data are extracted from clinical charts during hospitalization and are thus sub-optimal for answering post-discharge outcomes questions. This study aims to determine enablers and barriers to returning to the hospital after discharge among women who have undergone a c-section at a rural district hospital in Rwanda. Methods Women aged ≥ 18 years who underwent c-section at Kirehe District Hospital in rural Rwanda in the period March to October 2017 were prospectively followed. A structured questionnaire was administered to participants and clinical data were extracted from medical files between March and October 2017. At discharge, consenting women were given an appointment to return for follow-up on postoperative day 10 (POD 10) (± 3 days) and provided a voucher to cover transport and compensation for participation to be redeemed on their return. Study participants received a reminder call on the eve of their scheduled appointment. We used a backward stepwise logistic regression, at an α = 0.05 significance level, to identify enablers and barriers associated with post-discharge follow-up return. Results Of 586 study participants, the majority (62.6%) were between 21–30 years old and 86.4% had a phone contact number. Of those eligible, 90.4% returned for follow-up. The predictors of return were counselling by a female data collector (OR = 9.85, 95%CI:1.43–37.59) and receiving a reminder call (OR = 16.47, 95%CI:7.07–38.38). Having no insurance reduced the odds of returning to follow-up (OR = 0.03, 95%CI:0.03–0.23), and those who spent more than 10.6 Euro for transport to and from the hospital were less likely to return to follow-up (OR = 0.14, 95%CI:0.04- 0.50). Conclusion mHealh interventions using calls or notifications can increase the post-discharge follow-up uptake. The reminder calls to patients and discharge counselling by a gender-matching provider had a positive effect on return to care. Further interventions are needed targeting the uninsured and patients facing transportation hardship. Additionally, association between counselling of women patients by a female data collector and greater return to follow-up needs further exploration to optimize counselling procedures. |
| first_indexed | 2024-12-11T16:21:14Z |
| format | Article |
| id | doaj.art-0c94e37772a540efbe550c45b5fc2610 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-11T16:21:14Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-0c94e37772a540efbe550c45b5fc26102022-12-22T00:58:50ZengBMCBMC Health Services Research1472-69632022-06-0122111010.1186/s12913-022-08137-5Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural RwandaTheoneste Nkurunziza0Robert Riviello1Frederick Kateera2Edison Nihiwacu3Jonathan Nkurunziza4Magdalena Gruendl5Stefanie J. Klug6Bethany Hedt-Gauthier7Partners In Health/Inshuti Mu BuzimaDepartment of Global Health and Social Medicine, Harvard Medical SchoolPartners In Health/Inshuti Mu BuzimaPartners In Health/Inshuti Mu BuzimaPartners In Health/Inshuti Mu BuzimaEpidemiology Department of Sports and Health Sciences, Technical University of MunichEpidemiology Department of Sports and Health Sciences, Technical University of MunichDepartment of Global Health and Social Medicine, Harvard Medical SchoolAbstract Background Caesarean sections account for roughly one third of all surgical procedures performed in low-income countries. Due to lack of standardised post-discharge follow-up protocols and practices, most of available data are extracted from clinical charts during hospitalization and are thus sub-optimal for answering post-discharge outcomes questions. This study aims to determine enablers and barriers to returning to the hospital after discharge among women who have undergone a c-section at a rural district hospital in Rwanda. Methods Women aged ≥ 18 years who underwent c-section at Kirehe District Hospital in rural Rwanda in the period March to October 2017 were prospectively followed. A structured questionnaire was administered to participants and clinical data were extracted from medical files between March and October 2017. At discharge, consenting women were given an appointment to return for follow-up on postoperative day 10 (POD 10) (± 3 days) and provided a voucher to cover transport and compensation for participation to be redeemed on their return. Study participants received a reminder call on the eve of their scheduled appointment. We used a backward stepwise logistic regression, at an α = 0.05 significance level, to identify enablers and barriers associated with post-discharge follow-up return. Results Of 586 study participants, the majority (62.6%) were between 21–30 years old and 86.4% had a phone contact number. Of those eligible, 90.4% returned for follow-up. The predictors of return were counselling by a female data collector (OR = 9.85, 95%CI:1.43–37.59) and receiving a reminder call (OR = 16.47, 95%CI:7.07–38.38). Having no insurance reduced the odds of returning to follow-up (OR = 0.03, 95%CI:0.03–0.23), and those who spent more than 10.6 Euro for transport to and from the hospital were less likely to return to follow-up (OR = 0.14, 95%CI:0.04- 0.50). Conclusion mHealh interventions using calls or notifications can increase the post-discharge follow-up uptake. The reminder calls to patients and discharge counselling by a gender-matching provider had a positive effect on return to care. Further interventions are needed targeting the uninsured and patients facing transportation hardship. Additionally, association between counselling of women patients by a female data collector and greater return to follow-up needs further exploration to optimize counselling procedures.https://doi.org/10.1186/s12913-022-08137-5Post-discharge careGlobal surgerySub-Saharan AfricamHealthSurgical site infectionsFollow-up |
| spellingShingle | Theoneste Nkurunziza Robert Riviello Frederick Kateera Edison Nihiwacu Jonathan Nkurunziza Magdalena Gruendl Stefanie J. Klug Bethany Hedt-Gauthier Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural Rwanda BMC Health Services Research Post-discharge care Global surgery Sub-Saharan Africa mHealth Surgical site infections Follow-up |
| title | Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural Rwanda |
| title_full | Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural Rwanda |
| title_fullStr | Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural Rwanda |
| title_full_unstemmed | Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural Rwanda |
| title_short | Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural Rwanda |
| title_sort | enablers and barriers to post discharge follow up among women who have undergone a caesarean section experiences from a prospective cohort in rural rwanda |
| topic | Post-discharge care Global surgery Sub-Saharan Africa mHealth Surgical site infections Follow-up |
| url | https://doi.org/10.1186/s12913-022-08137-5 |
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