Feasibility, acceptability and preliminary effectiveness of the Hospital to Home discharge and follow-up programme in rural Uganda: a mixed-methods intervention study.

INTRODUCTION

Over 60% of premature infants are born in Africa or South Asia. Infants born early, small or who become sick after birth have a higher risk of death, poor growth and developmental impairments. Innovative interventions tailored for low- and middle-income countries are essential to help these newborns survive and develop optimally. This study evaluated the feasibility, acceptability and preliminary effectiveness of Hospital to Home (H2H), a discharge and follow-up programme for small and sick newborns in rural Uganda.

METHODS

We compared two cohorts of high-risk hospitalised neonates in Uganda: a historical-comparison cohort receiving standard facility-based care and an intervention cohort that received the H2H programme, a hospital and community spanning package of interventions designed to improve neurodevelopmental outcomes. We compared 6-month corrected neurodevelopmental, growth, nutritional and vaccination outcomes between the cohorts complemented by qualitative interviews of caregivers, community health workers and health facility staff.

RESULTS

We recruited 191 participants: 91 historical-comparison cohort (born between July and September 2018), and 100 intervention cohort (born July 2019 to February 2020). No statistically significant difference was seen in neurodevelopmental outcomes (adjusted OR 0.68; 95% CI: 0.32 to 1.46). Improved vaccination completion (88.5% intervention vs 76.9% comparison, p=0.041), and exclusive breastfeeding rates (42% vs 6.6%, p<0.001) were seen. Caregivers and healthcare workers reported the intervention to be acceptable and feasible in this rural Ugandan setting.

CONCLUSION

The H2H programme was feasible and acceptable to caregivers and healthcare providers. Improved vaccination and exclusive breastfeeding rates were seen in the intervention group when compared with a historical comparison cohort in this rural Ugandan setting. Further investigation on the short and long-term effectiveness of the H2H programme in a government health services setting is warranted.

TRIAL REGISTRATION NUMBER: ISRCTN51636372.