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-
1.
Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 2151–2161.
-
2.
Risk R, Naismith H, Burnett A, Moore SE, Cham M, Unger S, 2013. Rational prescribing in paediatrics in a resource-limited setting. Arch Dis Child 98: 503–509.
-
3.
Gove S, 1997. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ 75 (Suppl 1): 7–24.
-
4.
WHO/UNICEF, 2014. Integrated Management of Childhood Illness. Chart booklet. Available at: http://apps.who.int/iris/bitstream/10665/104772/16/9789241506823_Chartbook_eng.pdf?ua=1. Accessed March 25, 2014.
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5.
D'Acremont V, Kahama-Maro J, Swai N, Mtasiwa D, Genton B, Lengeler C, 2011. Reduction of anti-malarial consumption after rapid diagnostic tests implementation in Dar es Salaam: a before-after and cluster randomized controlled study. Malar J 10: 107.
-
6.
Hazir T, Nisar YB, Abbasi S, Ashraf YP, Khurshid J, Tariq P, Asghar R, Murtaza A, Masood T, Maqbool S, 2011. Comparison of oral amoxicillin with placebo for the treatment of world health organization-defined nonsevere pneumonia in children aged 2–59 months: a multicenter, double-blind, randomized, placebo-controlled trial in Pakistan. Clin Infect Dis 52: 293–300.
-
7.
Senn N, Rarau P, Salib M, Manong D, Siba P, Rogerson S, Mueller I, Genton B, 2014. Use of antibiotics within the IMCI guidelines in outpatient settings in Papua New Guinean children: an observational and effectiveness study. PLoS One 9: e90990.
-
8.
Rambaud-Althaus C, Althaus F, Genton B, D'Acremont V, 2015. Diagnostic value of clinical features for diagnosing pneumonia in children under five years of age: a systematic review and meta-analysis. Lancet Infect Dis 15: 439–450.
-
9.
Bruxvoort K, Kalolella A, Nchimbi H, Festo C, Taylor M, Thomson R, Cairns M, Thwing J, Kleinschmidt I, Goodman C, Kachur SP, 2013. Getting antimalarials on target: impact of national roll-out of malaria rapid diagnostic tests on health facility treatment in three regions of Tanzania. Trop Med Int Health 18: 1269–1282.
-
10.
Baiden F, Webster J, Owusu-Agyei S, Chandramohan D, 2011. Would rational use of antibiotics be compromised in the era of test-based management of malaria? Trop Med Int Health 16: 142–144.
-
11.
Lange S, Mwisongo A, Mæstad O, 2014. Why don't clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)? Soc Sci Med 104: 56–63.
-
12.
Rambaud-Althaus C, Shao AF, Kahama-Maro J, Genton B, D'Acremont V, 2015. Managing the sick child in the era of declining malaria transmission: development of ALMANACH, an electronic algorithm for appropriate use of antimicrobials. PLoS One 10: e0127674.
-
13.
Hartung C, Anokwa Y, Brunette W, Lerer A, Tseng C, Borriello G, In ICTD, 2010. Open Data Kit: Tools to Build Information Services for Developing Regions. Available at: http://dl.acm.org/citation.cfm?id=2369236. Accessed August 23, 2013.
-
14.
Wolfe BA, Mamlin BW, Biondich PG, Fraser HSF, Jaszayeri D, Allen C, Miranda J, Tierney WM, 2006. The OpenMRS system: collaborating toward an open source EMR for developing countries. AMIA Annu Symp Proc 2006: 1146.
-
15.
Shao AF, Rambaud-Althaus C, Samaka J, Faustine AF, Perri-Moore S, Swai N, Kahama-Maro J, Mitchell M, Genton B, D'Acremont V, 2015. New algorithm for managing childhood illness using mobile technology (ALMANACH): a controlled non-inferiority study on clinical outcome and antibiotic use in Tanzania. PLoS One 10: e0132316.
-
16.
National Bureau of Statistics, Ministry of Finances, 2012. Tanzania in Figures 2012: Population and Housing Census. Available at: http://www.nbs.go.tz/takwimu/references/Tanzania_in_figures2012.pdf. Accessed April 28, 2014.
-
17.
Mushi HP, Mullei K, Macha J, Wafula F, Borghi J, Goodman C, Gilson L, 2010. The challenges of achieving high training coverage for IMCI: case studies from Kenya and Tanzania. Health Policy Plan 26: 395–404.
-
18.
Piantadosi S, 2010. Randomization: Program to Generate Treatment Assignments for a Clinical Trial Using Block Stratified Randomization. Free Downloadable Software, Cedars-Sinai Medical Center. Available at: https://risccweb.csmc.edu/biostats/. Accessed April 10, 2014.
-
19.
WHO, 2001. Health Facility Survey Tool to Evaluate the Quality of Care Delivered to Sick Children Attending Outpatient Facilities: Using the Integrated Management of Childhood Illness Clinical Guidelines as Best Practices. Geneva, Switzerland: World Health Organization.
-
20.
Kyle Littlefield, Matthew Monroe, 2007. Venn Diagram Plotter, Pan-Omics Research. Richland, WA: Pacific Northwest National Laboratory. Available at: http://omics.pnl.gov/software/venn-diagram-plotter. Accessed January 6, 2015.
-
21.
Horwood C, Vermaak K, Rollins N, Haskins L, Nkosi P, Qazi S, 2009. An evaluation of the quality of IMCI assessments among IMCI trained health workers in South Africa. PLoS One 4: e5937.
-
22.
Rowe AK, Osterholt DM, Kouamé J, Piercefield E, Herman KM, Onikpo F, Lama M, Deming MS, 2012. Trends in health worker performance after implementing the Integrated Management of Childhood Illness strategy in Benin. Trop Med Int Health 17: 438–446.
-
23.
Thompson M, Mayon-White R, Harnden A, Perera R, McLeod D, Mant D, 2008. Using vital signs to assess children with acute infections: a survey of current practice. Br J Gen Pract 58: 236–241.
-
24.
Mitchell M, Hedt-Gauthier BL, Msellemu D, Nkaka M, Lesh N, 2013. Using electronic technology to improve clinical care—results from a before-after cluster trial to evaluate assessment and classification of sick children according to Integrated Management of Childhood Illness (IMCI) protocol in Tanzania. BMC Med Inform Decis Mak 13: 1–8.
-
25.
Mitchell M, Getchell M, Nkaka M, Msellemu D, Van Esch J, Hedt-Gauthier B, 2012. Perceived improvement in Integrated Management of Childhood Illness implementation through use of mobile technology: qualitative evidence from a pilot study in Tanzania. J Health Commun 17: 118–127.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 30 | 30 | 11 |
| Full Text Views | 423 | 119 | 1 |
| PDF Downloads | 183 | 45 | 0 |
Performance of Health Workers Using an Electronic Algorithm for the Management of Childhood Illness in Tanzania: A Pilot Implementation Study
Clotilde Rambaud-Althaus
Clotilde Rambaud-Althaus
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
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University of Basel, Basel, Switzerland.
Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
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Amani Shao
Amani Shao
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Tukuyu Medical Research Center, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania.
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University of Basel, Basel, Switzerland.
Tukuyu Medical Research Center, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania.
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Josephine Samaka
Josephine Samaka
City Medical Office of Health, Dar es Salaam City Council, Tanzania.
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Ndeniria Swai
Ndeniria Swai
City Medical Office of Health, Dar es Salaam City Council, Tanzania.
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Seneca Perri
Seneca Perri
University of Utah, Salt Lake City, Utah.
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Judith Kahama-Maro
Judith Kahama-Maro
City Medical Office of Health, Dar es Salaam City Council, Tanzania.
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Marc Mitchell
Marc Mitchell
Harvard School of Public Health, Boston, Massachusetts.
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Valérie D'Acremont
Valérie D'Acremont
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Travel Clinic, Department of Ambulatory Care and Community Medicine, and Infectious Disease Service, University of Lausanne, Lausanne, Switzerland.
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University of Basel, Basel, Switzerland.
Travel Clinic, Department of Ambulatory Care and Community Medicine, and Infectious Disease Service, University of Lausanne, Lausanne, Switzerland.
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Blaise Genton
Blaise Genton
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Travel Clinic, Department of Ambulatory Care and Community Medicine, and Infectious Disease Service, University of Lausanne, Lausanne, Switzerland.
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In low-resource settings, where qualified health workers (HWs) are scarce and childhood mortality high, rational antimicrobial prescription for childhood illnesses is a challenge. To assess whether smartphones running guidelines, as compared with paper support, improve consultation process and rational use of medicines for children, a pilot cluster-randomized controlled study was conducted in Tanzania. Nine primary health-care facilities (HFs) were randomized into three arms: 1) paper algorithm, 2) electronic algorithm on a smartphone, and 3) control. All HWs attending children aged 2–59 months for acute illness in intervention HFs were trained on a new clinical algorithm for management of childhood illness (ALMANACH) either on 1) paper or 2) electronic support; 4 months after training, consultations were observed. An expert consultation was the reference for classification and treatment. Main outcomes were proportion of children checked for danger signs, and antibiotics prescription rate. A total of 504 consultations (166, 171, and 167 in control, paper, and phone arms, respectively) were observed. The use of smartphones versus paper was associated with a significant increase in children checked for danger signs (41% versus 74%, P = 0.04). Antibiotic prescriptions rate dropped from 70% in the control to 26%, and 25% in paper and electronic arms. The HWs–expert agreement on pneumonia classification remained low (expert's pneumonia identified by HWs in 26%, 30%, and 39% of patients, respectively).Mobile technology in low-income countries is implementable and has a potential to improve HWs' performance. Additional point-of-care diagnostic tests are needed to ensure appropriate management. Improving the rational use of antimicrobial is a challenge that ALMANACH can help to take up.
Author Notes
Financial support: The study was part of a larger project that aimed at improving the quality of health care and rational use of drugs for children in Tanzania (PeDiAtrick project; Pan Africa Clinical Trial registration number PACTR201011000262218), funded by the Swiss National Science Foundation (grant number IZ70Z0-124023).
Authors' addresses: Clotilde Rambaud-Althaus, Swiss Tropical and Public Health Institute, Basel, Switzerland, E-mail: clotilde.rambaud@unibas.ch. Amani Shao, Tukuyu Medical Research Center, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania, E-mail: shaotz@gmail.com. Josephine Samaka and Ndeniria Swai, City Medical Office of Health, Dar es Salaam City Council, Tanzania, E-mails: docphine@yahoo.com and ndeniriaswai@gmail.com. Seneca Perri, University of Utah, Salt Lake City, UT, E-mail: iptsam@gmail.com. Marc Mitchell, Harvard School of Public Health, Boston, MA, E-mail: mmitchel@hsph.harvard.edu. Valérie D'Acremont and Blaise Genton, Travel Clinic, Department of Ambulatory Care and Community Medicine, Infectious Disease Service, University of Lausanne, Lausanne, Switzerland, E-mails: valerie.dacremont@unibas.ch and blaise.genton@unibas.ch.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 2151–2161.
-
2.
Risk R, Naismith H, Burnett A, Moore SE, Cham M, Unger S, 2013. Rational prescribing in paediatrics in a resource-limited setting. Arch Dis Child 98: 503–509.
-
3.
Gove S, 1997. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ 75 (Suppl 1): 7–24.
-
4.
WHO/UNICEF, 2014. Integrated Management of Childhood Illness. Chart booklet. Available at: http://apps.who.int/iris/bitstream/10665/104772/16/9789241506823_Chartbook_eng.pdf?ua=1. Accessed March 25, 2014.
-
5.
D'Acremont V, Kahama-Maro J, Swai N, Mtasiwa D, Genton B, Lengeler C, 2011. Reduction of anti-malarial consumption after rapid diagnostic tests implementation in Dar es Salaam: a before-after and cluster randomized controlled study. Malar J 10: 107.
-
6.
Hazir T, Nisar YB, Abbasi S, Ashraf YP, Khurshid J, Tariq P, Asghar R, Murtaza A, Masood T, Maqbool S, 2011. Comparison of oral amoxicillin with placebo for the treatment of world health organization-defined nonsevere pneumonia in children aged 2–59 months: a multicenter, double-blind, randomized, placebo-controlled trial in Pakistan. Clin Infect Dis 52: 293–300.
-
7.
Senn N, Rarau P, Salib M, Manong D, Siba P, Rogerson S, Mueller I, Genton B, 2014. Use of antibiotics within the IMCI guidelines in outpatient settings in Papua New Guinean children: an observational and effectiveness study. PLoS One 9: e90990.
-
8.
Rambaud-Althaus C, Althaus F, Genton B, D'Acremont V, 2015. Diagnostic value of clinical features for diagnosing pneumonia in children under five years of age: a systematic review and meta-analysis. Lancet Infect Dis 15: 439–450.
-
9.
Bruxvoort K, Kalolella A, Nchimbi H, Festo C, Taylor M, Thomson R, Cairns M, Thwing J, Kleinschmidt I, Goodman C, Kachur SP, 2013. Getting antimalarials on target: impact of national roll-out of malaria rapid diagnostic tests on health facility treatment in three regions of Tanzania. Trop Med Int Health 18: 1269–1282.
-
10.
Baiden F, Webster J, Owusu-Agyei S, Chandramohan D, 2011. Would rational use of antibiotics be compromised in the era of test-based management of malaria? Trop Med Int Health 16: 142–144.
-
11.
Lange S, Mwisongo A, Mæstad O, 2014. Why don't clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)? Soc Sci Med 104: 56–63.
-
12.
Rambaud-Althaus C, Shao AF, Kahama-Maro J, Genton B, D'Acremont V, 2015. Managing the sick child in the era of declining malaria transmission: development of ALMANACH, an electronic algorithm for appropriate use of antimicrobials. PLoS One 10: e0127674.
-
13.
Hartung C, Anokwa Y, Brunette W, Lerer A, Tseng C, Borriello G, In ICTD, 2010. Open Data Kit: Tools to Build Information Services for Developing Regions. Available at: http://dl.acm.org/citation.cfm?id=2369236. Accessed August 23, 2013.
-
14.
Wolfe BA, Mamlin BW, Biondich PG, Fraser HSF, Jaszayeri D, Allen C, Miranda J, Tierney WM, 2006. The OpenMRS system: collaborating toward an open source EMR for developing countries. AMIA Annu Symp Proc 2006: 1146.
-
15.
Shao AF, Rambaud-Althaus C, Samaka J, Faustine AF, Perri-Moore S, Swai N, Kahama-Maro J, Mitchell M, Genton B, D'Acremont V, 2015. New algorithm for managing childhood illness using mobile technology (ALMANACH): a controlled non-inferiority study on clinical outcome and antibiotic use in Tanzania. PLoS One 10: e0132316.
-
16.
National Bureau of Statistics, Ministry of Finances, 2012. Tanzania in Figures 2012: Population and Housing Census. Available at: http://www.nbs.go.tz/takwimu/references/Tanzania_in_figures2012.pdf. Accessed April 28, 2014.
-
17.
Mushi HP, Mullei K, Macha J, Wafula F, Borghi J, Goodman C, Gilson L, 2010. The challenges of achieving high training coverage for IMCI: case studies from Kenya and Tanzania. Health Policy Plan 26: 395–404.
-
18.
Piantadosi S, 2010. Randomization: Program to Generate Treatment Assignments for a Clinical Trial Using Block Stratified Randomization. Free Downloadable Software, Cedars-Sinai Medical Center. Available at: https://risccweb.csmc.edu/biostats/. Accessed April 10, 2014.
-
19.
WHO, 2001. Health Facility Survey Tool to Evaluate the Quality of Care Delivered to Sick Children Attending Outpatient Facilities: Using the Integrated Management of Childhood Illness Clinical Guidelines as Best Practices. Geneva, Switzerland: World Health Organization.
-
20.
Kyle Littlefield, Matthew Monroe, 2007. Venn Diagram Plotter, Pan-Omics Research. Richland, WA: Pacific Northwest National Laboratory. Available at: http://omics.pnl.gov/software/venn-diagram-plotter. Accessed January 6, 2015.
-
21.
Horwood C, Vermaak K, Rollins N, Haskins L, Nkosi P, Qazi S, 2009. An evaluation of the quality of IMCI assessments among IMCI trained health workers in South Africa. PLoS One 4: e5937.
-
22.
Rowe AK, Osterholt DM, Kouamé J, Piercefield E, Herman KM, Onikpo F, Lama M, Deming MS, 2012. Trends in health worker performance after implementing the Integrated Management of Childhood Illness strategy in Benin. Trop Med Int Health 17: 438–446.
-
23.
Thompson M, Mayon-White R, Harnden A, Perera R, McLeod D, Mant D, 2008. Using vital signs to assess children with acute infections: a survey of current practice. Br J Gen Pract 58: 236–241.
-
24.
Mitchell M, Hedt-Gauthier BL, Msellemu D, Nkaka M, Lesh N, 2013. Using electronic technology to improve clinical care—results from a before-after cluster trial to evaluate assessment and classification of sick children according to Integrated Management of Childhood Illness (IMCI) protocol in Tanzania. BMC Med Inform Decis Mak 13: 1–8.
-
25.
Mitchell M, Getchell M, Nkaka M, Msellemu D, Van Esch J, Hedt-Gauthier B, 2012. Perceived improvement in Integrated Management of Childhood Illness implementation through use of mobile technology: qualitative evidence from a pilot study in Tanzania. J Health Commun 17: 118–127.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 30 | 30 | 11 |
| Full Text Views | 423 | 119 | 1 |
| PDF Downloads | 183 | 45 | 0 |