Feasibility of Post‐Operative Telehealth for Pediatric Surgical Patients in Malawi—A Mixed Methods Analysis

BACKGROUND: Pediatric operative volumes in Malawi have increased over the past decade due to an increase in the pediatric surgical workforce and improved infrastructure. Despite growth in surgical capacity, limited data exist regarding post-operative outcomes for common surgical diseases in low-resource settings. METHODS: Guardians of patients < 18 years old undergoing general surgery operations at Kamuzu Central Hospital (KCH) were recruited. Two telephone call attempts 30-day after the operation were made to administer a follow-up questionnaire and an Acceptability of Intervention Measure (AIM) score. Guardians were then purposively sampled for semi-structured interviews to assess participant experiences in the telephone follow-up protocol. Feasibility of telehealth follow up, defined here as reachability and acceptability, and guardian perceived factors affecting reachability were analyzed. RESULTS: Of 327 families approached for recruitment, 309 (94.5%) had access to a phone. After accounting for clinical events, 292 were eligible for a 30-day phone call. The majority of patients were male (70.6%) and the median age was 2 years old (IQR: 0.02-14). Overall, 69.2% (n = 202) were reached via phone call. Participants with secondary phones had increased odds of reachability (OR = 2.0, p = 0.04) compared to those with only a primary phone. The mean AIM score of the reached group was 18.3 (SD: 2.6). Among the interviewees-phone ownership, cellular network access, phone charge, and community influence were identified as key factors affecting participation in telephone follow-up. CONCLUSIONS: Post-operative follow-up via phone call is feasible in Malawi as evidenced by high patient reachability and acceptability. The results of this pilot study support scaling up implementation of telehealth follow-up in Malawi and utilizing the resulting post-operative metrics to guide quality improvement of surgical care.