Performance of Health Workers Using an Electronic Algorithm for the Management of Childhood Illness in Tanzania: A Pilot Implementation Study.

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.

Rambaud-Althaus C ，Shao A ，Samaka J ，Swai N ，Perri S ，Kahama-Maro J ，Mitchell M ，D'Acremont V ，Genton B ... -  《-》

A novel electronic algorithm using host biomarker point-of-care tests for the management of febrile illnesses in Tanzanian children (e-POCT): A randomized, controlled non-inferiority trial.

Keitel K ，Kagoro F ，Samaka J ，Masimba J ，Said Z ，Temba H ，Mlaganile T ，Sangu W ，Rambaud-Althaus C ，Gervaix A ，Genton B ，D'Acremont V ... -  《-》

Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective.

Shao AF ，Rambaud-Althaus C ，Swai N ，Kahama-Maro J ，Genton B ，D'Acremont V ，Pfeiffer C ... -  《-》

New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania.

Shao AF ，Rambaud-Althaus C ，Samaka J ，Faustine AF ，Perri-Moore S ，Swai N ，Kahama-Maro J ，Mitchell M ，Genton B ，D'Acremont V ... -  《PLoS One》

Managing the Sick Child in the Era of Declining Malaria Transmission: Development of ALMANACH, an Electronic Algorithm for Appropriate Use of Antimicrobials.

Rambaud-Althaus C ，Shao AF ，Kahama-Maro J ，Genton B ，d'Acremont V ... -  《PLoS One》