Gannon, Hannah; (2025) Evaluating implementation of a neonatal digital health tool in crisis-affected Zimbabwe. Doctoral thesis (Ph.D), UCL (University College London).

	Text (Thesis) Gannon_10208503_thesis.pdf Access restricted to UCL open access staff until 1 June 2026. Download (5MB)
	Text (Supplementary Information) Gannon_10208503_thesis_appendix.pdf Access restricted to UCL open access staff until 1 June 2026. Download (724kB)

Abstract

INTRODUCTION: In low-resource settings, such as Zimbabwe, improvements in neonatal survival have been constrained by healthcare system limitations, compounded by external crises such as healthcare-provider strikes and the COVID-19 pandemic. Many newborn deaths are clinically preventable through the implementation of low-cost evidence-based interventions. Neotree is a tablet-based application designed to address this gap to standardise and optimise newborn care in low-resource settings whilst gathering high quality routine clinical data. METHODS: I conducted a mixed-methods evaluation of Neotree focused on exploring the impact of crises on quality neonatal care, to optimise two key functionalities: high quality digital data capture and neonatal emergency management support. Alongside Neotree data quality analysis, I conducted an interrupted time series analysis, using data captured via Neotree, to explore trends in admission and case fatality rates across crisis and non-crisis periods and assessed key relevant quality of care indicators. I collected qualitative data through focus groups, interviews, and ethnographic observations to explore barriers and facilitators to Neotree usage. RESULTS: Neotree remained an accurate data source despite crises and had greater completeness compared to the current gold standard paper-based systems. There was a significant reduction in admissions over the crisis periods and industrial action had a greater effect on outcomes and, more broadly, access to facility-based healthcare than the COVID-19 pandemic. This PhD identified key barriers to Neotree use during crises including limited induction training, reduced resource availability and heightened time constraints and work burden, as well as highlighting facilitators such as timely clinical decision support and standardised practice. Key implementation strategies were developed based on these findings. CONCLUSION: This thesis underscores the significant impact of crises, specifically industrial action, on neonatal quality care in Zimbabwe. These findings emphasise the need and potential utility of adaptive digital health strategies in resource-constrained settings to improve neonatal outcomes and healthcare resilience.

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