title: New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania.
abstract: BACKGROUND
  The decline of malaria and scale-up of rapid diagnostic tests calls for a revision of IMCI. A new algorithm (ALMANACH) running on mobile technology was developed based on the latest evidence. The objective was to ensure that ALMANACH was safe, while keeping a low rate of antibiotic prescription.
  
  
  METHODS
  Consecutive children aged 2-59 months with acute illness were managed using ALMANACH (2 intervention facilities), or standard practice (2 control facilities) in Tanzania. Primary outcomes were proportion of children cured at day 7 and who received antibiotics on day 0.
  
  
  RESULTS
  130/842 (15∙4%) in ALMANACH and 241/623 (38∙7%) in control arm were diagnosed with an infection in need for antibiotic, while 3∙8% and 9∙6% had malaria. 815/838 (97∙3%;96∙1-98.4%) were cured at D7 using ALMANACH versus 573/623 (92∙0%;89∙8-94∙1%) using standard practice (p<0∙001). Of 23 children not cured at D7 using ALMANACH, 44% had skin problems, 30% pneumonia, 26% upper respiratory infection and 13% likely viral infection at D0. Secondary hospitalization occurred for one child using ALMANACH and one who eventually died using standard practice. At D0, antibiotics were prescribed to 15∙4% (12∙9-17∙9%) using ALMANACH versus 84∙3% (81∙4-87∙1%) using standard practice (p<0∙001). 2∙3% (1∙3-3.3) versus 3∙2% (1∙8-4∙6%) received an antibiotic secondarily.
  
  
  CONCLUSIONS
  Management of children using ALMANACH improve clinical outcome and reduce antibiotic prescription by 80%. This was achieved through more accurate diagnoses and hence better identification of children in need of antibiotic treatment or not. The building on mobile technology allows easy access and rapid update of the decision chart.
  
  
  BACKGROUND
  Pan African Clinical Trials Registry PACTR201011000262218.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; National Institute for Medical Research, Tukuyu Medical Research Center, Tukuyu, Tanzania.
authors.forename: Amani Flexson
authors.initials: AF
authors.lastname: Shao
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Clotilde
authors.initials: C
authors.lastname: Rambaud-Althaus
authors.affiliation: Amana Hospital, Dar es Salaam, Tanzania.
authors.forename: Josephine
authors.initials: J
authors.lastname: Samaka
authors.affiliation: Kilombero District Council, PO Box 263, Morogoro, Tanzania.
authors.forename: Allen Festo
authors.initials: AF
authors.lastname: Faustine
authors.affiliation: University of Utah, Salt Lake City, Utah, United States of America.
authors.forename: Seneca
authors.initials: S
authors.lastname: Perri-Moore
authors.affiliation: City Medical Office of Health, Dar es Salaam City Council, Dar es Salaam, Tanzania.
authors.forename: Ndeniria
authors.initials: N
authors.lastname: Swai
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; City Medical Office of Health, Dar es Salaam City Council, Dar es Salaam, Tanzania.
authors.forename: Judith
authors.initials: J
authors.lastname: Kahama-Maro
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Marc
authors.initials: M
authors.lastname: Mitchell
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland; Infectious Diseases Service, University Hospital, Lausanne, Switzerland.
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland.
authors.forename: Valérie
authors.initials: V
authors.lastname: D'Acremont
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D019468:Disease Management; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D000068997:Smartphone; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents