title: Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective.
abstract: BACKGROUND
  The impact of the Integrated Management of Childhood Illness (IMCI) strategy has been less than anticipated because of poor uptake. Electronic algorithms have the potential to improve quality of health care in children. However, feasibility studies about the use of electronic protocols on mobile devices over time are limited. This study investigated constraining as well as facilitating factors that influence the uptake of a new electronic Algorithm for Management of Childhood Illness (ALMANACH) among primary health workers in Dar es Salaam, Tanzania.
  
  
  METHODS
  A qualitative approach was applied using in-depth interviews and focus group discussions with altogether 40 primary health care workers from 6 public primary health facilities in the three municipalities of Dar es Salaam, Tanzania. Health worker's perceptions related to factors facilitating or constraining the uptake of the electronic ALMANACH were identified.
  
  
  RESULTS
  In general, the ALMANACH was assessed positively. The majority of the respondents felt comfortable to use the devices and stated that patient's trust was not affected. Most health workers said that the ALMANACH simplified their work, reduced antibiotic prescription and gave correct classification and treatment for common causes of childhood illnesses. Few HWs reported technical challenges using the devices and complained about having had difficulties in typing. Majority of the respondents stated that the devices increased the consultation duration compared to routine practice. In addition, health system barriers such as lack of staff, lack of medicine and lack of financial motivation were identified as key reasons for the low uptake of the devices.
  
  
  CONCLUSIONS
  The ALMANACH built on electronic devices was perceived to be a powerful and useful tool. However, health system challenges influenced the uptake of the devices in the selected health facilities.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. shaotz@gmail.com.|University of Basel, Basel, Switzerland. shaotz@gmail.com.|National Institute for Medical Research, Tukuyu Medical Research Center, Tukuyu, Tanzania. shaotz@gmail.com.
authors.forename: Amani Flexson
authors.initials: AF
authors.lastname: Shao
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. rambaud.c@gmail.com.|University of Basel, Basel, Switzerland. rambaud.c@gmail.com.
authors.forename: Clotilde
authors.initials: C
authors.lastname: Rambaud-Althaus
authors.affiliation: City Medical Office of Health, Dar es Salaam City Council, Tanzania. ndeniriaswai@gmail.com.
authors.forename: Ndeniria
authors.initials: N
authors.lastname: Swai
authors.affiliation: City Medical Office of Health, Dar es Salaam City Council, Tanzania.
authors.forename: Judith
authors.initials: J
authors.lastname: Kahama-Maro
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. blaise.genton@unibas.ch.|University of Basel, Basel, Switzerland. blaise.genton@unibas.ch.|Infectious Diseases Service and Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland. blaise.genton@unibas.ch.
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. valerie.dacremont@unibas.ch.|University of Basel, Basel, Switzerland. valerie.dacremont@unibas.ch.|Infectious Diseases Service and Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland. valerie.dacremont@unibas.ch.
authors.forename: Valerie
authors.initials: V
authors.lastname: D'Acremont
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. constanze.pfeiffer@unibas.ch.|University of Basel, Basel, Switzerland. constanze.pfeiffer@unibas.ch.
authors.forename: Constanze
authors.initials: C
authors.lastname: Pfeiffer
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D000067576:Child Health; D054626:Consumer Health Information / Q000706:statistics & numerical data*; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D036301:Qualitative Research; D011787:Quality of Health Care; D000068997:Smartphone / Q000706:statistics & numerical data*; D013636:Tanzania