title: Performance of Health Workers Using an Electronic Algorithm for the Management of Childhood Illness in Tanzania: A Pilot Implementation Study.
abstract: 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.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. clotilde.rambaud@unibas.ch.|University of Basel, Basel, Switzerland.|Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
authors.forename: Clotilde
authors.initials: C
authors.lastname: Rambaud-Althaus
authors.affiliation: 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.
authors.forename: Amani
authors.initials: A
authors.lastname: Shao
authors.affiliation: City Medical Office of Health, Dar es Salaam City Council, Tanzania.
authors.forename: Josephine
authors.initials: J
authors.lastname: Samaka
authors.affiliation: City Medical Office of Health, Dar es Salaam City Council, Tanzania.
authors.forename: Ndeniria
authors.initials: N
authors.lastname: Swai
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Seneca
authors.initials: S
authors.lastname: Perri
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: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Marc
authors.initials: M
authors.lastname: Mitchell
authors.affiliation: 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.
authors.forename: Valérie
authors.initials: V
authors.lastname: D'Acremont
authors.affiliation: 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.
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
mesh_terms: D000465:Algorithms; D000067576:Child Health; D002675:Child, Preschool; D003150:Community Health Workers; D006801:Humans; D007223:Infant; D010865:Pilot Projects; D019095:Point-of-Care Systems; D011787:Quality of Health Care; D000068997:Smartphone; D013636:Tanzania