Usability and acceptability of electronic immunization registry (EIR) data-entry workflows from the healthcare worker perspective in Siaya, Kenya

Thesis (Master's)--University of Washington, 2020Introduction: Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health (MOH) and the International Training and Education Centre for Health in Kenya (I-TECH-Kenya) implemented an EIR system in all 161 of Siaya county’s immunizing clinics between 2018 – 2019. Successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the healthcare workers (HCWs) using the EIR. Without full adoption of the EIR by HCWs into their clinic workflow, many of the potential benefits of the EIR cannot be realized. This study evaluates HCW perceptions of usability and acceptability of multiple clinic workflows using the new EIR. Methods: We performed a mixed-methods pre-post study using semi-structured interviews of healthcare workers at 6 facilities in Gem sub-county of Siaya county, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after implementation of each of three different workflow modifications (n=24 interviews). The interviews used a combination of open-ended interview questions and scale-based indicators based on the NASA Task Load Index and usability heuristics. The baseline state involved dual data-entry with paper records and the EIR. We implemented the three workflow modifications for one full day each: fully paperless data entry, preparation of an appointment diary prior to the day’s patient visits began, and a combination of paperless plus preparation workflows together. We compared aggregate scores from the indicators and interview themes across each of the four workflows in order to understand changes in usability and acceptability of the EIR. Results: We found that, overall, the EIR clinic workflows were considered usable and acceptable by the HCWs. Of the modified workflows, we found the HCWs perceived the fully paperless workflow to be the most favorable, while the baseline, preparation, and combined workflows had mixed results. In all workflows, benefits perceived by the HCWs included ease of clinical decision-making using the EIR, reduced mental burden of the data entry when using the EIR, and ease of identification of errors. Challenges perceived by the HCWs regarding workflow acceptability included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors saving records and missing fields, and workflow challenges such as the dual data entry burden of paper and digital tools. Conclusion: Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon presence of supporting contextual clinic factors and resolution of system performance and design challenges. An acceptable EIR will provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Rather than trying to identify a singular best workflow, future efforts to optimize EIR implementation should look for ways to maximize flexibility, reliability of the app, and strong enabling environments, and let the HCWs in each clinic match the EIR to their real-world context to have the best results for data use

Cost of childhood RSV management and cost-effectiveness of RSV interventions: a systematic review from a low- and middle-income country perspective

Abstract Background Approximately 97% of global deaths due to RSV occur in low- and middle-income countries (LMICs). Until recently, the only licensed preventive intervention has been a shortacting monoclonal antibody (mAb), palivizumab (PVZ) that is expensive and intensive to administer, making it poorly suited for low-resource settings. Currently, new longer acting RSV mAbs and maternal vaccines are emerging from late-stage clinical development with promising clinical effectiveness. However, evidence of economic value and affordability must also be considered if these interventions are to be globally accessible. This systematic review’s objective was to summarise existing evidence on the cost-of-illness (COI) and cost-effectiveness of RSV prevention interventions in LMICs. Methods We conducted a systematic literature review using the Embase, MEDLINE, and Global Index Medicus databases for publications between Jan 2000 and Jan 2022. Two categories of studies in LMICs were targeted: cost-of-illness (COI) of RSV episodes and cost-effectiveness analyses (CEA) of RSV preventive interventions including maternal vaccines and long-acting mAbs. Of the 491 articles reviewed, 19 met the inclusion criteria. Results COI estimates varied widely: for severe RSV, the cost per episode ranged from $92 to$4114. CEA results also varied—e.g. evaluations of long-acting mAbs found ICERs from $462/DALY averted to$2971/DALY averted. Study assumptions of input parameters varied substantially and their results often had wide confidence intervals. Conclusions RSV represents a substantial disease burden; however, evidence of economic burden is limited. Knowledge gaps remain regarding the economic value of new technologies specifically in LMICs. Further research is needed to understand the economic burden of childhood RSV in LMICs and reduce uncertainty about the relative value of anticipated RSV prevention interventions. Most CEA studies evaluated palivizumab with fewer analyses of interventions in development that may be more accessible for LMICs

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations