title: Managing the Sick Child in the Era of Declining Malaria Transmission: Development of ALMANACH, an Electronic Algorithm for Appropriate Use of Antimicrobials.
abstract: OBJECTIVE
  To review the available knowledge on epidemiology and diagnoses of acute infections in children aged 2 to 59 months in primary care setting and develop an electronic algorithm for the Integrated Management of Childhood Illness to reach optimal clinical outcome and rational use of medicines.
  
  
  METHODS
  A structured literature review in Medline, Embase and the Cochrane Database of Systematic Review (CDRS) looked for available estimations of diseases prevalence in outpatients aged 2-59 months, and for available evidence on i) accuracy of clinical predictors, and ii) performance of point-of-care tests for targeted diseases. A new algorithm for the management of childhood illness (ALMANACH) was designed based on evidence retrieved and results of a study on etiologies of fever in Tanzanian children outpatients.
  
  
  RESULTS
  The major changes in ALMANACH compared to IMCI (2008 version) are the following: i) assessment of 10 danger signs, ii) classification of non-severe children into febrile and non-febrile illness, the latter receiving no antibiotics, iii) classification of pneumonia based on a respiratory rate threshold of 50 assessed twice for febrile children 12-59 months; iv) malaria rapid diagnostic test performed for all febrile children. In the absence of identified source of fever at the end of the assessment, v) urine dipstick performed for febrile children <2 years to consider urinary tract infection, vi) classification of 'possible typhoid' for febrile children >2 years with abdominal tenderness; and lastly vii) classification of 'likely viral infection' in case of negative results.
  
  
  CONCLUSIONS
  This smartphone-run algorithm based on new evidence and two point-of-care tests should improve the quality of care of <5 year children and lead to more rational use of antimicrobials.
authors.affiliation: Epidemiology and Public Health department, 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: Epidemiology and Public Health department, 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: 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: Epidemiology and Public Health department, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Infectious Disease Service, University Hospital, Lausanne, Switzerland; Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland.
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
authors.affiliation: Epidemiology and Public Health department, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Infectious Disease Service, University Hospital, Lausanne, Switzerland.
authors.forename: Valérie
authors.initials: V
authors.lastname: d'Acremont
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000379:methods; D019468:Disease Management; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D010961:Plasmodium / Q000187:drug effects / Q000302:isolation & purification; D019095:Point-of-Care Systems; D000068997:Smartphone; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000962:Antimalarials