Browsing by Author "Hewitt-Smith, Adam"

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    Acceptability of immediate CPAP for preterm infants in the delivery room to mothers, caregivers and healthcare workers in a low-resource setting: a qualitative study
    (BMC Pediatrics, 2025) Napyo, Agnes; Nakiyemba, Alice; Muduwa, Martha; Ssenkusu, M. John; Okello, Francis; Hagmann, Cornelia; Namuyonga, Judith; Hewitt-Smith, Adam; Loe, Kate; Abongo, Grace; Amorut, Denis; Wandabwa, Julius; Olupot-Olupot, Peter; Burgoine, Kathy
    Background: Preterm birth is the leading cause of childhood mortality, with respiratory distress syndrome as the predominant aetiology. Initiating continuous positive airways pressure (CPAP) immediately after birth may reduce CPAP failure, the need for ventilation, and surfactant use. In low-resource settings, without ventilation or surfactant, immediate CPAP could significantly reduce preterm mortality. We explored the experiences, perceptions, and acceptability of immediate CPAP among parents, caregivers, and healthcare workers in a Ugandan hospital. Methods: This qualitative study (April 2023–April 2024) was nested in a pilot randomised controlled trial of immediate delivery room CPAP for very low birthweight infants (VLBW, <1500 g) at a government hospital in Uganda. Data were collected through 12 key informant interviews and focus group discussions with 36 healthcare workers, and 37 parents and caregivers of enrolled infants. We applied deductive framework analysis using the Theoretical Framework of Acceptability (TFA) and coded transcripts using Nvivo 12. Results: Regarding affective attitude, healthcare workers, mothers and caregivers expressed positive feelings towards immediate CPAP. For perceived effectiveness, healthcare workers described immediate CPAP as a prophylactic intervention that reduces the severity of complications and shortens hospital stays, while mothers and caregivers believed it expands the infant’s lungs and increases chances of survival. Concerning burden, healthcare workers highlighted that successful implementation depends on a committed neonatal team, multidisciplinary team collaboration, adequate staffing, active maternal involvement, and the availability of sufficient CPAP machines. Opportunity costs were evident where limited staffing forced healthcare workers to choose between prioritising the mother or the infant. Under ethicality, cultural beliefs, religious views, and fear were identified as influential factors in decision making around immediate CPAP. Regarding intervention coherence, healthcare workers, mothers, and caregivers demonstrated a good understanding of the purpose and process of immediate CPAP. Finally, self-efficacy was linked to the availability of adequate staff, training, and necessary equipment to confidently engage in the intervention. Conclusions Immediate CPAP was found to be acceptable among healthcare workers and mothers/caregivers. Successful implementation requires adequate staff training, comprehensive health education, adequate human resources, and sufficient availability of CPAP machines. Trial registration Study is registered on Pan African Clinical Trials Registry (PACTR) PACTR202208462613789. Keywords Preterm, Very low birthweight, VLBW, Africa, Neonatal, CPAP, Respiratory distress syndrome, Low-resource setting, Acceptability, Barriers, Facilitators, Attitude
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    Family supplemented patient monitoring : an intervention to prevent failure to rescue after surgery in Ugandan hospitals.
    (Queen Mary University of London, 2025) Hewitt-Smith, Adam
    Background: Patients who have surgery in Uganda are twice as likely to die compared the global average, despite being younger and fitter. Most deaths happen on the hospital wards after surgery following post-operative complications. There is limited evidence of ways to reduce this ‘failure to rescue’ in these settings. Interventions that utilise existing resources such as family members need to be developed and explored further. Methods: This thesis includes a systematic review, one-year observational cohort study, steppedwedge cluster randomised controlled trial, and concurrent mixed methods process evaluation which together describe the development and testing of a complex intervention to deliver family supplemented patient monitoring after surgery at the Mbale Regional Referral Hospital in Uganda. I compared the total number of sets of vital signs using an incident rate ratio and used logistic regression to analyse mortality after surgery. Qualitative data were analysed with a deductive approach using the consolidated framework for intervention research. Results: 93/4773 (2.0%) patients having surgery died before hospital discharge. This rises to 68/304 (22.4%) for patients undergoing elective or emergency laparotomy. 73/83 (88.0%) of these deaths occur on the postoperative wards. During the SMARTER pilot trial of 1395 patients in four hospital wards, the median (IQR) number of sets of vital signs monitoring per three-day study period in the usual care group was 0 [0-1] compared with 3 [1-8] in the intervention group, where family members supplemented vital signs monitoring of patients after surgery (Incident rate ratio: 12.4 [8.8 to 17.5], p=<0.001). My process evaluation identified both positive factors influencing the intervention such as the ‘relative advantage’, and negative factors such as the ‘available resources’, ‘culture’ and ‘compatibility’. Conclusions: Family supplemented patient monitoring results in significantly higher rates of vital signs monitoring for patients after surgery. This intervention was successfully implemented in a low-resource regional hospital in Uganda