Smart Discharges are a way to help mothers, newborns, and children stay healthy after they leave the hospital to return home. Children hospitalized for serious infections in Africa have a very high post-discharge mortality rate. This means that many children who seem healthy after an infection return to their homes and then get sick again and die. In places like Uganda, as many children die during the weeks after they are discharged from a hospital as die during hospitalization — about 5% in each case. One solution is identifying vulnerable children before they go home from the hospital so that we can make sure they have the tools to survive after they go home. This is the Smart Discharge model.
We are now extending this model to identify and improve care for mothers and newborns following discharge from healthcare facilities after birth. This is a vulnerable period that carries a high risk of death and complication for the mother-newborn dyad.
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.
Mothers and babies are at higher risk of dying in the first six weeks after birth. The World Health Organization (WHO) recommends regular follow-up visits for all mothers and their newborns. However, follow-up visits are not possible in many poor countries. The lack of money and nurses at hospitals and limited time and money at home stop mothers from seeking care for themselves and their babies. In our study we identify mother-baby pairs that are most at-risk of getting sick or dying using the Smart Mom+Baby risk score at the time of birth. A baby is more likely to get sick if its mother is sick. The mother is more likely to get sick if the baby is sick. Our risk score looks at both the mother's and baby's risk. The combined risk for the mother and baby can then be used by a nurse to guide the number of follow-up visits recommended for the pair, with mothers and babies at higher risks receiving the most number of visits. This allows mothers and babies at high risk to get good care when they need it. Our approach is ideally suited to poor countries where nurses and money are limited. In this study we will build our risk score, working at different types of hospitals across Uganda. We will also talk to mothers, grandmothers, fathers, midwives, nurses, and doctors to determine what stops mothers and newborns from receiving a follow-up visit. We will find ways to remove these barriers and ensure that improvements in care are long-lasting. To do this, we will use more than 10 years of experience making risk scores that help nurses and doctors make better choices about treating patients in poor countries.