Smart Discharges for Mom & Baby: Saving Mother-newborn Dyads by Developing a Predictive Risk Model to Identify Vulnerable Dyads and Guide Delivery of Evidence-based, Locally-informed Interventions for Targeted Post-discharge Care

PURPOSE

Neonatal outcomes are highly correlated with the health of the mother, an example of this is shown repeatedly by poor rates of survival of infants after maternal death. Prediction of risk, based on the mother and infant as a pair, is a major gap in current research and yet vital to the survival of both the mom and the infant. Thus, maternal and child health outcomes can be improved by identifying both mothers and babies at increased risk of mortality or serious morbidity after hospital discharge and allocating scarce resources for targeted follow-up to those most vulnerable. This allows the investigators to not only improve health outcomes but benefits the health system with efficient use of resources.

JUSTIFICATION

Since 2011, the investigators have been working with partners in Uganda to develop, validate, and implement an innovative program for children under 5 years who have been discharged following hospitalization for suspected sepsis. In this research and implementation program, called Smart Discharges, healthcare workers use an individualized risk prediction score to identify children at high risk of death or complications after discharge from a hospital following treatment for suspected sepsis. They can then use this score to guide the intensity of a counselling and community-referral program. While all participants receive counselling, only those above a certain risk threshold receive down-referrals to community health facilities. The investigators have shown that this approach may reduce post-discharge child mortality after in-hospital treatment for suspected sepsis by as much as 30%. Now, the investigators are working to expand their innovative precision public health approach to improving post-discharge care for mother-newborn dyads.

Findings will inform the development an evidence-based bundle of care for both the mother and newborn. This package will ensure that low-risk mother-infant pairs receive less burdensome (yet pragmatic and feasible) postpartum care, while high risk pairs receive a more extensive bundle of interventions (such as education, nutrition, healthcare interaction and community support). The Smart Discharges for Mom & Baby package will include support targeting aspects of both clinical and emotional wellbeing. Additional extensions of this work will include validating the risk models in women who deliver at home or suffer a stillbirth to ensure that more women and babies can benefit from the proposed intervention.