Caesarean sections account for roughly one third of all surgical procedures performed in low-income countries. Due to lack of standardised post-discharge follow-up protocols and practices, most of available data are extracted from clinical charts during hospitalization and are thus sub-optimal for answering post-discharge outcomes questions. This study aims to determine enablers and barriers to returning to the hospital after discharge among women who have undergone a c-section at a rural district hospital in Rwanda.
Women aged ≥ 18 years who underwent c-section at Kirehe District Hospital in rural Rwanda in the period March to October 2017 were prospectively followed. At discharge, consenting women were given an appointment to return for follow-up on postoperative day 10 (POD 10) (±3days) and provided a voucher to cover transport and compensation for participation to be redeemed on their return. Study participants received a reminder call on the eve of their scheduled appointment. We used a backward stepwise logistic regression, at an α=0.05 significance level, to identify enablers and barriers associated with post-discharge follow-up return.
Of 586 study participants, the majority were between 21-30 years old (62.6%, n=367), had primary education (70.0%, n=410), were farmers (86.7%, n=508), earned less than 31.8 Euro/month (92.7%, n=543), had a phone contact number (86.4%, n=506), and were discharged by POD3 (73.2% n=423). Of those eligible, 90.4% (n=530) returned for follow-up. The predictors of return were counseling by a female data collector (OR=9.85, 95%CI:1.43-37.59) and receiving a reminder call (OR=16.47, 95%CI:7.07-38.38). Having no insurance reduced the odds of returning to follow-up (OR=0.03, 95%CI:0.03-0.23), and those who spent more than 10.6 Euro for transport to and from the hospital were less likely to return to follow-up (OR=0.14, 95%CI:0.04- 0.50).
mHealh interventions using calls or notifications can increase the post-discharge follow-up uptake. The reminder calls to patients and counselling by a gender-matching provider had a positive effect on return to care. Further interventions are needed targeting the uninsured and patients facing transportation hardship. Additionally, association between counseling of women patients by a female data collector and greater return to follow-up needs further exploration to optimize counseling procedures.