📖 ABSTRACT/OVERVIEW
Post-discharge monitoring of orthopaedic fracture patients in rural Nigeria is severely limited by geographic barriers, transport costs, and inadequate community health infrastructure, contributing to missed complications, failed implants, and preventable disability. Mobile health (mHealth) technologies offer a promising scalable solution for bridging this care gap. This study designs, implements, and evaluates a mobile health intervention for remote post-discharge monitoring of orthopaedic fracture patients in rural communities of Ogun and Ondo States, South West Nigeria, using a stepped-wedge cluster randomised controlled trial design. The mHealth intervention comprises an SMS-based symptom monitoring system with automated red-flag alerts to a clinical triage nurse, supplemented by a voice call follow-up protocol at two, six, and twelve weeks post-discharge. Eight rural primary health centre clusters will be randomised to intervention periods according to a stepped-wedge schedule. Primary outcomes include 90-day orthopaedic complication rate and emergency readmission rate. Secondary outcomes encompass patient satisfaction, physiotherapy engagement, implant failure detection time, and health system cost. Process evaluation using the Medical Research Council complex intervention framework will assess intervention fidelity and mechanisms of impact. The study hypothesises that the mHealth intervention reduces 90-day complications by at least 25 percent. Findings will contribute an original implementation science model for mHealth-assisted fracture care in rural West Africa. Keywords: mobile health, post-discharge monitoring, orthopaedic fractures, stepped-wedge trial, rural Nigeria.
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