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

Beatrice Niyonshaba; Daniel Kabugo; Cornety Nakiganda; Christine Otai; Margret Seela; Joyce Nankabala; James Nyonyintono; Josephine Nakakande; Tadeo Kigozi; Madeline Vaughan; Heidi Nakamura; Mohan Paudel; Kimber Haddix-Mckay; Benjamin J.S. Al-Haddad; Cally J. Tann; Paul Mubiri; Peter Waiswa; Brooke Magnusson

doi:10.1136/bmjgh-2024-015945

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

Beatrice Niyonshaba, Daniel Kabugo, Cornety Nakiganda, Christine Otai, Margret Seela, Joyce Nankabala, James Nyonyintono, Josephine Nakakande, Tadeo Kigozi, Madeline Vaughan, Heidi Nakamura, Mohan Paudel, Kimber Haddix-Mckay, Benjamin J.S. Al-Haddad, Cally J. Tann, Paul Mubiri, Peter Waiswa, Brooke Magnusson

Public and Community Health Sciences

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

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.

Original language	English
Article number	e015945
Journal	BMJ Global Health
Volume	10
Issue number	2
DOIs	https://doi.org/10.1136/bmjgh-2024-015945
State	Published - Feb 12 2025

Keywords

Child health
Global Health
Follow-Up Studies
Humans
Patient Discharge
Male
Infant
Feasibility Studies
Rural Population
Infant, Premature
Uganda
Female
Program Evaluation
Infant, Newborn
Patient Acceptance of Health Care/statistics & numerical data
Cohort Studies

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjgh-2024-015945

Cite this

Niyonshaba, B., Kabugo, D., Nakiganda, C., Otai, C., Seela, M., Nankabala, J., Nyonyintono, J., Nakakande, J., Kigozi, T., Vaughan, M., Nakamura, H., Paudel, M., Haddix-Mckay, K., Al-Haddad, B. J. S., Tann, C. J., Mubiri, P., Waiswa, P., & Magnusson, B. (2025). Feasibility, acceptability and preliminary effectiveness of the Hospital to Home discharge and follow-up programme in rural Uganda: A mixed-methods intervention study. BMJ Global Health, 10(2), Article e015945. https://doi.org/10.1136/bmjgh-2024-015945

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

abstract = "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.",

keywords = "Child health, Global Health, Follow-Up Studies, Humans, Patient Discharge, Male, Infant, Feasibility Studies, Rural Population, Infant, Premature, Uganda, Female, Program Evaluation, Infant, Newborn, Patient Acceptance of Health Care/statistics & numerical data, Cohort Studies",

author = "Beatrice Niyonshaba and Daniel Kabugo and Cornety Nakiganda and Christine Otai and Margret Seela and Joyce Nankabala and James Nyonyintono and Josephine Nakakande and Tadeo Kigozi and Madeline Vaughan and Heidi Nakamura and Mohan Paudel and Kimber Haddix-Mckay and Al-Haddad, {Benjamin J.S.} and Tann, {Cally J.} and Paul Mubiri and Peter Waiswa and Brooke Magnusson",

note = "{\textcopyright} Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.",

year = "2025",

month = feb,

day = "12",

doi = "10.1136/bmjgh-2024-015945",

language = "English",

volume = "10",

journal = "BMJ Global Health",

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number = "2",

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Niyonshaba, B, Kabugo, D, Nakiganda, C, Otai, C, Seela, M, Nankabala, J, Nyonyintono, J, Nakakande, J, Kigozi, T, Vaughan, M, Nakamura, H, Paudel, M, Haddix-Mckay, K, Al-Haddad, BJS, Tann, CJ, Mubiri, P, Waiswa, P & Magnusson, B 2025, 'Feasibility, acceptability and preliminary effectiveness of the Hospital to Home discharge and follow-up programme in rural Uganda: A mixed-methods intervention study', BMJ Global Health, vol. 10, no. 2, e015945. https://doi.org/10.1136/bmjgh-2024-015945

TY - JOUR

T1 - Feasibility, acceptability and preliminary effectiveness of the Hospital to Home discharge and follow-up programme in rural Uganda

T2 - A mixed-methods intervention study

AU - Niyonshaba, Beatrice

AU - Kabugo, Daniel

AU - Nakiganda, Cornety

AU - Otai, Christine

AU - Seela, Margret

AU - Nankabala, Joyce

AU - Nyonyintono, James

AU - Nakakande, Josephine

AU - Kigozi, Tadeo

AU - Vaughan, Madeline

AU - Nakamura, Heidi

AU - Paudel, Mohan

AU - Haddix-Mckay, Kimber

AU - Al-Haddad, Benjamin J.S.

AU - Tann, Cally J.

AU - Mubiri, Paul

AU - Waiswa, Peter

AU - Magnusson, Brooke

N1 - © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

PY - 2025/2/12

Y1 - 2025/2/12

N2 - 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.

AB - 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.

KW - Child health

KW - Global Health

KW - Follow-Up Studies

KW - Humans

KW - Patient Discharge

KW - Male

KW - Infant

KW - Feasibility Studies

KW - Rural Population

KW - Infant, Premature

KW - Uganda

KW - Female

KW - Program Evaluation

KW - Infant, Newborn

KW - Patient Acceptance of Health Care/statistics & numerical data

KW - Cohort Studies

UR - http://www.scopus.com/inward/record.url?scp=85217954748&partnerID=8YFLogxK

U2 - 10.1136/bmjgh-2024-015945

DO - 10.1136/bmjgh-2024-015945

M3 - Article

C2 - 39939110

AN - SCOPUS:85217954748

SN - 2059-7908

VL - 10

JO - BMJ Global Health

JF - BMJ Global Health

IS - 2

M1 - e015945

ER -

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

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Keywords

UN SDGs

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