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Our research aims to reduce preventable neonatal mortality by empowering sustainable, widespread improvement in the perinatal and postnatal clinical care of newborns.
Since 2016 we have worked in Malawi, Zimbabwe, and the UK to co-develop and pilot the Neotree learning healthcare systems. Pilot implementation evaluation data from ~13,000 babies and 353 healthcare professionals show high acceptability, feasibility and usability, improvements in ability to deliver newborn care, but also highlighted gaps in knowledge in newborn care and quality improvement.
Wellcome Trust Digital Innovation Award
Funded by a Wellcome Trust digital innovation award (2019-2022) our current programme of research is focussed on completing the co-development of Neotree-gamma with key functionalities configured, operationalised, tested and ready for large scale roll out across low resource settings (diagnostic algorithm, local clinical data dashboard and linkage to local and national databases). Our specific objectives are to:
- Further co-develop and test the Neotree at tertiary facilities in Malawi and Zimbabwe
- Investigate HCPs and parent/carer view of the Neotree, including how acceptable and usable HCWs find the app, and potential barriers and enablers to implementing/using it in practice
- Test the clinical validity of key Neotree diagnostic algorithms, e.g. neonatal sepsis and hypoxic ischaemic encephalopathy (HIE) against gold standard or best available standard diagnoses
- Develop and test proof of concept for communicating daily electronic medical records (EMR) using Neotree
- Initiate a multi-country network of newborn health care workers, policy makers and academics
- Estimate cost of implementing Neotree at all sites and potential costs at scale
Future research and implementation objectives include:
- Within a trial setting, evaluate clinical and cost-effectiveness of the current version of Neotree to reduce facility-based newborn case fatality rates in Zimbabwe
- Extend Neotree to new outcomes (perinatal care) and populations so as to help with the care of more than a million babies and mothers annually in Zimbabwe and Malawi
- Analyse data from Neotree to improve clinical decision support and provide population-level management information
- Develop and assess specific training modules for neonatal care and quality improvement
Neotree deployment has been robust despite external crises (e.g., industrial action, economic collapse and COVID-19) and data have been used to improve care and monitor healthcare outcomes during COVID-19. COVID-19 clinical management and infection control guidance was incorporated into the Neotree app. We have demonstrated the ability to rapidly adapt and respond, for example, in response to clinical evidence of a recent rise in fresh stillbirths (most likely due to indirect impacts of COVID-19 on health service provision and use), we mobilised within one week our planned implementation of stillbirth data collection in Zimbabwe.
ETHOS and VALUES
The Neotree is not for profit and not for data. All Neotree code is open-source and local clinical teams maintain data ownership.
Collaboration
Collaboration is at the heart of our approach: we collaborate closely with health care professionals, families and communities, hospitals, Ministries of Health, academic partners, NGOs, donors and the broader health ecosystem to implement and evolve our technology, and other organisations working to improve neonatal healthcare.
Neotree data from Zimbabwe are being used as part of a national study assessing the impact of COVID-19 pandemic on maternal infant transmission of HIV (www.clinicaltrials.gov/ct2/show/NCT04782739 ). In Malawi we have worked closely with the local NEST360 team on data quality and resource/equipment allocation. We are collaborating with GOAL3 to pilot integration of Neotree with a Bluetooth physiological monitoring system (IMPALA) for newborn care.
Rigour
We are evidence-led: we are committed to building a solid, scientific evidence base for everything we do including understanding the impact of the Neotree technology.
Impact
Our focus is on reducing neonatal mortality: specifically targeting those deaths that can be prevented using simple, proven interventions.
Integrity
We are committed to transparency and honesty, and are driven entirely by our mission.
Innovation
We seize the opportunities provided by technology to support and enable our mission.
