Sherri L. Bucher

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https://hdl.handle.net/1805/43172

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A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: does Helping Babies Breathe training save lives?
(BioMed Central, 2016) Bellad, Roopa M.; Bang, Akash; Carlo, Waldemar; McClure, Elizabeth M.; Meleth, Sreelatha; Goco, Norman; Goudar, Shivaprasad S.; Derman, Richard J.; Hibberd, Patricia L.; Patel, Archana; Esamai, Fabian; Bucher, Sherri; Gisore, Peter; Wright, Linda L.; Department of Pediatrics, IU School of Medicine
Background Whether facility-based implementation of Helping Babies Breathe (HBB) reduces neonatal mortality at a population level in low and middle income countries (LMIC) has not been studied. Therefore, we evaluated HBB implementation in this context where our study team has ongoing prospective outcome data on all pregnancies regardless of place of delivery. Methods We compared outcomes of birth cohorts in three sites in India and Kenya pre-post implementation of a facility-based intervention, using a prospective, population-based registry in 52 geographic clusters. Our hypothesis was that HBB implementation would result in a 20 % decrease in the perinatal mortality rate (PMR) among births ≥1500 g. Results We enrolled 70,704 births during two 12-month study periods. Births within each site did not differ pre-post intervention, except for an increased proportion of <2500 g newborns and deliveries by caesarean section in the post period. There were no significant differences in PMR among all registry births; however, a post-hoc analysis stratified by birthweight documented improvement in <2500 g mortality in Belgaum in both registry and in HBB-trained facility births. No improvement in <2500 g mortality measures was noted in Nagpur or Kenya and there was no improvement in normal birth weight survival. Conclusions Rapid scale up of HBB training of facility birth attendants in three diverse sites in India and Kenya was not associated with consistent improvements in mortality among all neonates ≥1500 g; however, differential improvements in <2500 g survival in Belgaum suggest the need for careful implementation of HBB training with attention to the target population, data collection, and ongoing quality monitoring activities.
Self-reported practices among traditional birth attendants surveyed in western Kenya: a descriptive study
(BioMed Central, 2016-08-12) Bucher, Sherri; Konana, Olive; Liechty, Edward; Garces, Ana; Gisore, Peter; Marete, Irene; Tenge, Constance; Shipala, Evelyn; Wright, Linda; Esami, Fabian; Department of Pediatrics, IU School of Medicine
BACKGROUND: The high rate of home deliveries conducted by unskilled birth attendants in resource-limited settings is an important global health issue because it is believed to be a significant contributing factor to maternal and newborn mortality. Given the large number of deliveries that are managed by unskilled or traditional birth attendants outside of health facilities, and the fact that there is on-going discussion regarding the role of traditional birth attendants in the maternal newborn health (MNH) service continuum, we sought to ascertain the practices of traditional birth attendants in our catchment area. The findings of this descriptive study might help inform conversations regarding the roles that traditional birth attendants can play in maternal-newborn health care. METHODS: A structured questionnaire was used in a survey that included one hundred unskilled birth attendants in western Kenya. Descriptive statistics were employed. RESULTS: Inappropriate or outdated practices were reported in relation to some obstetric complications and newborn care. Encouraging results were reported with regard to positive relationships that traditional birth attendants have with their local health facilities. Furthermore, high rates of referral to health facilities was reported for many common obstetric emergencies and similar rates for reporting of pregnancy outcomes to village elders and chiefs. CONCLUSIONS: Potentially harmful or outdated practices with regard to maternal and newborn care among traditional birth attendants in western Kenya were revealed by this study. There were high rates of traditional birth attendant referrals of pregnant mothers with obstetric complications to health facilities. Policy makers may consider re-educating and re-defining the roles and responsibilities of traditional birth attendants in maternal and neonatal health care based on the findings of this survey.
Development of an Innovative Mobile Phone-Based Newborn Care Training Application
(Springer, 2019) Bucher, Sherri; Meyers, Elizabeth; Kshatriya, Bhavani Singh Agnikula; Avanigadda, Prem Chand; Purkayastha, Saptarshi; BioHealth Informatics, School of Informatics and Computing
Mobile infrastructure in low - and middle-income countries (LMIC) has shown immense potential to reach the unreachable. Healthcare providers (HCP) are one such group who are at the frontline of the fight against infant mortality in LMICs. Mortality among newborn infants (birth to 28 days) now accounts for around 45% of all under 5-years child mortality. Birth asphyxia is one of the three leading causes of newborn death; neonatal resuscitation training, among health care providers, reduces mortality from birth asphyxia. We have developed a mobile phone-based training app, called mobile Helping Babies Survive (mHBS), to support the training of health care providers on neonatal resuscitation. mHBS is integrated with the District Health Information System (DHIS2) platform, which is used in over 60 countries around the world. The mHBS/DHIS2 training app is a part of an application suite which includes another DHIS2-linked data collection app, mHBS tracker. The mHBS training application has the potential to scale-up integration with other neonatal training apps. Ultimately, the mHBS training suite will provide new insights into healthcare worker education along with the necessary tools for effective care of newborn babies.
Engagement and Usability of a Cognitive Behavioral Therapy Mobile App Compared With Web-Based Cognitive Behavioral Therapy Among College Students: Randomized Heuristic Trial
(JMIR, 2020) Purkayastha, Saptarshi; Addepally, Siva Abhishek; Bucher, Sherri; BioHealth Informatics, School of Informatics and Computing
Background: Recent evidence in mobile health has demonstrated that, in some cases, apps are an effective way to improve health care delivery. Health care interventions delivered via mobile technology have demonstrated both practicality and affordability. Lately, cognitive behavioral therapy (CBT) interventions delivered over the internet have also shown a meaningful impact on patients with anxiety and depression. Objective: Given the growing proliferation of smartphones and the trust in apps to support improved health behaviors and outcomes, we were interested in comparing a mobile app with Web-based methods for the delivery of CBT. This study aimed to compare the usability of a CBT mobile app called MoodTrainer with an evidence-based website called MoodGYM. Methods: We used convenience sampling to recruit 30 students from a large Midwestern university and randomly assigned them to either the MoodGYM or MoodTrainer user group. The trial period ran for 2 weeks, after which the students completed a self-assessment survey based on Nielsen heuristics. Statistical analysis was performed to compare the survey results from the 2 groups. We also compared the number of modules attempted or completed and the time spent on CBT strategies. Results: The results indicate that the MoodTrainer app received a higher usability score when compared with MoodGYM. Overall, 87% (13/15) of the participants felt that it was easy to navigate through the MoodTrainer app compared with 80% (12/15) of the MoodGYM participants. All MoodTrainer participants agreed that the app was easy to use and did not require any external assistance, whereas only 67% (10/15) had the same opinion for MoodGYM. Furthermore, 67% (10/15) of the MoodTrainer participants found that the navigation controls were easy to locate compared with 80% (12/15) of the MoodGYM participants. MoodTrainer users, on average, completed 2.5 modules compared with 1 module completed by MoodGYM users. Conclusions: As among the first studies to directly compare the usability of a mobile app–based CBT with smartphone-specific features against a Web-based CBT, there is an opportunity for app-based CBT as, at least in our limited trial, it was more usable and engaging. The study was limited to evaluate usability only and not the clinical effectiveness of the app.
Towards a Modelling Framework for Self-Sovereign Identity Systems
(Cornell University, 2020-09-09) Barclay, Iain; Freytsis, Maria; Bucher, Sherri; Radha, Swapna; Preece, Alun; Taylor, Ian; Pediatrics, School of Medicine
Self-sovereign Identity promises to give users control of their own data, and has the potential to foster advancements in terms of personal data privacy. Self-sovereign concepts can also be applied to other entities, such as datasets and devices. Systems adopting this paradigm will be decentralised, with messages passing between multiple actors, both human and representing other entities, in order to issue and request credentials necessary to meet individual and collective goals. Such systems are complex, and build upon social and technical interactions and behaviours. Modelling self-sovereign identity systems seeks to provide stakeholders and software architects with tools to enable them to communicate effectively, and lead to effective and well-regarded system designs and implementations. This paper draws upon research from Actor-based Modelling to guide a way forward in modelling self-sovereign systems, and reports early success in utilising the iStar 2.0 framework to provide a representation of a birth registration case study.
The Development and Usability Testing of a Decision Support Mobile App for the Essential Care for Every Baby (ECEB) Program
(Springer, 2019) Nuthakki, Siddhartha; Bucher, Sherri; Purkayastha, Saptarshi; BioHealth Informatics, School of Informatics and Computing
mHealth is a pervasive and ubiquitous technology which has revolutionized the healthcare system for both health providers and patients (Wang et al. 2016). Each year, globally, about 15 million babies are born too soon (premature) or too small (low birthweight small for gestational age); among these 2.7 million newborns die every year due to complications from prematurity (Every New Born 2014). Common complications of prematurity like feeding problems, and hypothermia lead to high rates of morbidity and mortality among prematurely born babies each year. Delivery of evidence-based essential newborn care interventions, from birth through the first 24 h of postnatal life, has been shown to improve health and well-being, and reduce mortality, among newborns. However, due to a variety of barriers, bottlenecks, and challenges, many babies born in resource-limited settings do not receive the full complement of these lifesaving interventions. In order to address these challenges, the American Academy of Pediatrics (AAP) has developed an integrated educational and training curriculm for health care providers and family stakeholders in LMICs called Essential Care for Every Baby (ECEB). ECEB has an Action Plan, which serves as a decision support tool and job aid for health care providers. (Figure 1), by synthesizing research over a decade on helping babies survive (Essential Care for Every Baby 2018). This program teaches health care providers essential newborn care practices to keep all babies healthy from the time of birth to discharge from the facility. Yet, the nuances of monitoring, tracking and taking care of multiple babies simultaneously in neonatal wards has a big cognitive load on nurses, who must perform tasks every few minutes on each baby. The care is divided into three phases based on the time after birth: Phase 1 (0–60 min), Phase 2 (60–90 min), Phase 3 (90 min-24 h). We iteratively developed and tested the usability of the ECEB action plan, as part of the mobile Helping Babies Survive (mHBS) suite of apps, and plan to field test the app in the near future.
Essential Care for Every Baby: Neonatal Clinical Decision Support Tool
(Springer, 2020-07) Rajapuri, Anushri Singh; Ravindran, Radhika; Horan, Kevin; Bucher, Sherri; Purkayastha, Saptarshi; Medicine, School of Medicine
Unacceptably high rates of neonatal mortality are an urgent global health challenge. Consistent application of Essential Newborn Care (ENC) interventions reduce newborn mortality. However, ENC has failed to scale-up in low-middle income countries, where the bulk of neonatal deaths occur. The American Academy of Pediatrics designed an evidence-based, simplified training and educational curriculum called Essential Care for Every Baby (ECEB), which includes a clinical practice guideline for the time of delivery through 24 h after birth. However, the scale-up of ECEB has been hampered by the need to provide a wide variety of time-sensitive ECEB interventions to numerous mother-baby pairs. This incurs significant cognitive load among providers who perform varied tasks every few minutes for each baby. In this high-load, stressful situation, there are often profound gaps in the delivery of crucial ECEB strategies. We propose an innovative, scalable, clinical decision support mobile app which prioritizes recognition over recall and addresses existing challenges.
Regional trends in birth weight in low- and middle-income countries 2013–2018
(BMC, 2020-12-17) Marete, Irene; Ekhaguere, Osayame; Bann, Carla M.; Bucher, Sherri L.; Nyongesa, Paul; Patel, Archana B.; Hibberd, Patricia L.; Saleem, Sarah; Goldenberg, Robert L.; Goudar, Shivaprasad S.; Derman, Richard J.; Garces, Ana L.; Krebs, Nancy F.; Chomba, Elwyn; Carlo, Waldemar A.; Lokangaka, Adien; Bauserman, Melissa; Koso‑Thomas, Marion; Moore, Janet L.; McClure, Elizabeth M.; Esamai, Fabian; Pediatrics, School of Medicine
Background: Birth weight (BW) is a strong predictor of neonatal outcomes. The purpose of this study was to compare BWs between global regions (south Asia, sub-Saharan Africa, Central America) prospectively and to determine if trends exist in BW over time using the population-based maternal and newborn registry (MNHR) of the Global Network for Women'sand Children's Health Research (Global Network). Methods: The MNHR is a prospective observational population-based registryof six research sites participating in the Global Network (2013-2018), within five low- and middle-income countries (Kenya, Zambia, India, Pakistan, and Guatemala) in threeglobal regions (sub-Saharan Af rica, south Asia, Central America). The birth weights were obtained for all infants born during the study period. This was done either by abstracting from the infants' health facility records or from direct measurement by the registry staff for infants born at home. After controlling for demographic characteristics, mixed-effect regression models were utilized to examine regional differences in birth weights over time. Results: The overall BW meanswere higher for the African sites (Zambia and Kenya), 3186 g (SD 463 g) in 2013 and 3149 g (SD 449 g) in 2018, ascompared to Asian sites (Belagavi and Nagpur, India and Pakistan), 2717 g (SD450 g) in 2013 and 2713 g (SD 452 g) in 2018. The Central American site (Guatemala) had a mean BW intermediate between the African and south Asian sites, 2928 g (SD 452) in 2013, and 2874 g (SD 448) in 2018. The low birth weight (LBW) incidence was highest in the south Asian sites (India and Pakistan) and lowest in the African sites (Kenya and Zambia). The size of regional differences varied somewhat over time with slight decreases in the gap in birth weights between the African and Asian sites and slight increases in the gap between the African and Central American sites. Conclusions: Overall, BWmeans by global region did not change significantly over the 5-year study period. From 2013 to 2018, infants enrolled at the African sites demonstrated the highest BW means overall across the entire study period, particularly as compared to Asian sites. The incidence of LBW was highest in the Asian sites (India and Pakistan) compared to the African and Central American sites. Trial registration The study is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475.
Caesarean birth by maternal request: a poorly understood phenomenon in low- and middle-income countries
(Oxford University Press, 2021-01-14) Harrison, Margo S.; Garces, Ana; Figueroa, Lester; Esamai, Fabian; Bucher, Sherri; Bose, Carl; Goudar, Shivaprasad; Derman, Richard; Patel, Archana; Hibberd, Patricia L.; Chomba, Elwyn; Mwenechanya, Miusaku; Hambidge, Michael; Krebs, Nancy F.; Medicine, School of Medicine
Background: While trends in caesarean birth by maternal request in low- and middle-income countries are unclear, age, education, multiple gestation and hypertensive disease appear associated with the indication when compared with caesarean birth performed for medical indications. Methods: We performed a secondary analysis of a prospectively collected population-based study of home and facility births using descriptive statistics, bivariate comparisons and multilevel mixed-effects logistic regression. Results: Of 28 751 patients who underwent caesarean birth and had a documented primary indication for the surgery, 655 (2%) were attributed to caesarean birth by maternal request. The remaining 98% were attributed to maternal and foetal indications and prior caesarean birth. In a multilevel mixed effects logistic regression adjusted for site and cluster of birth, when compared with caesareans performed for medical indications, caesarean birth performed for maternal request had a higher odds of being performed among women ≥35 y of age, with a university or higher level of education, with multiple gestations and with pregnancies complicated by hypertension (P < 0.01). Caesarean birth by maternal request was associated with a two-times increased odds of breastfeeding within 1 h of delivery, but no adverse outcomes (when compared with women who underwent caesarean birth for medical indications; P < 0.01). Conclusion: Caesarean performed by maternal request is more common in older and more educated women and those with multifoetal gestation or hypertensive disease. It is also associated with higher rates of breastfeeding within 1 h of delivery.
Cost estimation alongside a multi-regional, multi-country randomized trial of antenatal ultrasound in five low-and-middle-income countries
(BMC, 2021-05-20) Bresnahan, B. W.; Vodicka, E.; Babigumira, J. B.; Malik, A. M.; Yego, F.; Lokangaka, A.; Chitah, B. M.; Bauer, Z.; Chavez, H.; Moore, J. L.; Garrison, L. P.; Swanson, J. O.; Swanson, D.; McClure, E. M.; Goldenberg, R. L.; Esamai, F.; Garces, A. L.; Chomba, E.; Saleem, S.; Tshefu, A.; Bose, C. L.; Bauserman, M.; Carlo, W.; Bucher, S.; Liechty, E. A.; Nathan, R. O.; Pediatrics, School of Medicine
Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency.

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