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Improving quality of health care for Tanzanian children: Assessing the use of electronic decision support to promote evidence-based medicine and rational use of drugs

English title Improving quality of health care for Tanzanian children: Assessing the use of electronic decision support to promote evidence-based medicine and rational use of drugs
Applicant Genton Blaise
Number 124023
Funding scheme Resource not found: 'bd31932a-e257-46d9-9dba-079f6f2c77c6'
Research institution Department of Epidemiology and Public Health Swiss Tropical and Public Health Institute Universität Basel
Institution of higher education University of Basel - BS
Main discipline Tropical Medicine
Start/End 01.09.2009 - 31.12.2012
Approved amount 540'000.00
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All Disciplines (3)

Discipline
Tropical Medicine
Infectious Diseases
Public Health and Health Services

Keywords (12)

IMCI; Personal Digital Assistant; evidence-based medicine; antibiotics; antimalarials; childhood illness; case management; electronic; decision chart; mobile phone; antibiotic; rational use drug

Lay Summary (English)

Lead
Lay summary
Improving quality of health care for Tanzanian children: Assessing the use of electronic decision support to promote evidence-based medicine and rational use of drugs (PeDiAtrick)SummaryNearly 10 million children die each year before the age of 5 despite the fact that effective low-cost interventions are available. Integrated Management of Childhood Illness (IMCI) treatment algorithms have proved, when used correctly, to improve quality of care, reduce the cost of treatment, and reduce under-5 mortality. However, the actual impact of IMCI worldwide has been less than anticipated due to limited uptake of the intervention, and poor adherence to algorithms by clinicians. A recent study in Tanzania showed poor adherence to the IMCI protocols, resulting to low quality of care. Indeed 99% of the children attending outpatient clinics with fever who tested negative for malaria were prescribed antibiotics, although this was appropriate in less than 20%. Such procedures lead to poor health outcomes, huge wastage of drugs and rapid spread of bacterial resistance.The rapidly changing patterns of disease and drug resistance of microorganisms, the poor adherence to clinical guidelines using paper based algorithms and the increasing availability of new technologies for more accurate diagnostics and better adherence to evidence based clinical algorithms are the basis of this project. We will test whether the technologies that are available today can be used to improve the quality of care that is being provided to Tanzanian children through the use of electronic decision support to promote evidence-based medicine and the use of rapid diagnostic tests which promote the rational use of drugs.In particular, we expect to show that it is feasible and cost effective to"Revise standardized diagnostic and treatment procedures for the management of childhood illness (IMCI) incorporating more sophisticated clinical algorithms based on current evidence about disease patterns and drug resistance; "Rapidly incorporate these changes into case management algorithms in an electronic format that is accurately used; "Demonstrate improved clinical and cost effectiveness of electronic algorithms when compared to the used of paper based IMCI algorithms leading to a reduction in the inappropriate use of antibiotics and antimalarials for children with fever, and therefore improve the quality of care that is being provided to children in Tanzania.We expect to show that the use of decision support systems using mobile technology will enhance the ability to improve and rapidly implement evidence based clinical algorithms by improving adherence of health workers to these improved algorithms, leading to better health outcomes and more rational use of antimalarial drugs and antibiotics, when compared to paper-based decision charts or usual health facility procedures.Keywords: rational use of drugs, antibiotics, integrated management of childhood illness (IMCI), personal digital assistant (PDA), algorithm
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Name Institute

Project partner

Publications

Publication
Performance of Health Workers Using an Electronic Algorithm for the Management of Childhood Illness in Tanzania: A Pilot Implementation Study.
Genton Blaise (2017), Performance of Health Workers Using an Electronic Algorithm for the Management of Childhood Illness in Tanzania: A Pilot Implementation Study., in American Journal of Tropical Medicine and Hygiene, 2017 Jan 11;96(1):249-257. ( 2017 Jan ), 249-257.
Using an eIMCI-Derived Decision Support Protocol to Improve Provider-Caretaker Communication for Treatment of Children Under 5 in Tanzania.
Genton Blaise, Perri-Moore S Routen T Shao AF Rambaud-Althaus C Swai N Kahama-Maro J D'Acremont V (2016), Using an eIMCI-Derived Decision Support Protocol to Improve Provider-Caretaker Communication for Treatment of Children Under 5 in Tanzania., in Global Health Community , 2015;1(1):41-47. (2015;1(1):), 41-47.
Managing the Sick Child in the Era of Declining Malaria Transmission: Development of ALMANACH, an Electronic Algorithm for Appropriate Use of Antimicrobials.
Genton Blaise, Rambaud-Althaus C Shao AF Kahama-Maro J Genton B d'Acremont V. (2015), Managing the Sick Child in the Era of Declining Malaria Transmission: Development of ALMANACH, an Electronic Algorithm for Appropriate Use of Antimicrobials., in PLoS One., 2015 Jul 10;10(7):e0127674.(2015 Jul 1), 1-19.
New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania
Genton Blaise, Shao AF1 Rambaud-Althaus C2 Samaka J Faustine AF Perri-Moore S Swai N Kahama-Maro J Mitc (2015), New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania, in PLoS One , 2015 Jul 10;10(7):e0132316(2015 Jul 1), 1-15.
Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis.
Genton Blaise, Clotilde Rambaud-Althaus Fabrice AlthausValérie D’Acremont (2015), Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis., in Lancet Infectious Diseases , (2015 Apr;1), 439-450.
Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective
GentonBlaise, Shao AF Rambaud-Althaus C Swai N Kahama-Maro J D'Acremont V P (2015), Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective, in BMC Health Service Research , (2015 Apr 2), 1-12.
Causes of fever in outpatient Tanzanian children
Genton Blaise (2014), Causes of fever in outpatient Tanzanian children, in New England Journal of Medicine , (2014 Jun 5), 2242-2244.
Beyond malaria: etiologies of fever in Tanzanian children attending outpatient clinics
Genton Blaise, Valérie D’Acremont M.D. Ph.D. Mary Kilowoko M.P.H. Esther Kyungu M.D. M.P.H. (2014), Beyond malaria: etiologies of fever in Tanzanian children attending outpatient clinics, in New England Journal of Medicine , (2014 Feb 2), 809-817.
Smartphones to improve health workers performance and rational use of drugs for the management of childhood illnesses in a low resource setting
Rambaud-Althaus C Shao A Swai N Perri S Mitchell M Kahama-Maro J D’Acremont V Genton B (2012), Smartphones to improve health workers performance and rational use of drugs for the management of childhood illnesses in a low resource setting, in Abstract book of the61st Annual Meeting of the ASTMH.
Management of Childhood Illnesses: development of a new algorithm (ALMANACH) to promote evidence-based medicine and rational use of dr
Rambaud-Althaus C Shao A Kahama-Maro J Genton B D’Acremont V. (2011), Management of Childhood Illnesses: development of a new algorithm (ALMANACH) to promote evidence-based medicine and rational use of dr, in Abstract book of the 7th ECTMIH.
Safety of a new ALgorithm for the MANAgement of CHildhood illness (ALMANACH) to improve quality of care and rational use of drugs.
Shao A Rambaud-Althaus C Perri S Swai N Kahama-Maro J Mitchell M Genton B D’Acremont V (2011), Safety of a new ALgorithm for the MANAgement of CHildhood illness (ALMANACH) to improve quality of care and rational use of drugs., in abstract book of the 7th ECTMIH, Barcelona 2011.
Influenza and other respiratory viruses among febrile childre
D'Acremont V Cherpillod P Kilowoko M Kyungu E Philipina S Sangu W Kahama-Maro J Y. Thomas Al (2010), Influenza and other respiratory viruses among febrile childre, in Abstract book of the 50th ICAAC,.
Beyond malaria: etiologies of fever in young children attending outpatient clinics in urban and rural Tanzania
D’Acremont V Kilowoko M Kyungu E Sister Philipina Sangu W Kahama-Maro J Lengeler C Cherpillo, Beyond malaria: etiologies of fever in young children attending outpatient clinics in urban and rural Tanzania, in New England Journal of Medicine, in press.

Collaboration

Group / person Country
Types of collaboration
Dar es Salaam City Medical Office of Health Tanzania (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Harvard School of Public Health United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Exchange of personnel
World Health Organization, Global Malaria programme Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Exchange of personnel
Infectious Disease Service, University Hospital Geneva Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Prof. Toshiro Shirakawa, International Center, Kobe University School of Medicine Japan (Asia)
- in-depth/constructive exchanges on approaches, methods or results
Ifakara Health Institute Tanzania (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel

Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Management of fever; Result dissemination Performances, exhibitions (e.g. for education institutions) 19.05.2015 Dar es Salaam, Tanzania Genton Blaise;


Self-organised

Title Date Place
Integrated community case management 23.01.2013 WHO Geneva, Switzerland

Communication with the public

Communication Title Media Place Year
Media relations: print media, online media A carrier for the less privileged; the right tools for the right job International Innovation International 2013

Associated projects

Number Title Start Funding scheme
146993 Investigations of enterovirus meningitis and central nervous system/respiratory diseases of unrecognized viral etiology. 01.04.2013 Project funding (Div. I-III)
109696 Understanding and improving malaria diagnosis in health facilities in Dar es Salaam, Tanzania 01.01.2006 Resource not found: 'bd31932a-e257-46d9-9dba-079f6f2c77c6'

Abstract

BackgroundNearly 10 million children die each year before the age of 5 despite the fact that effective low-cost interventions are available. Integrated Management of Childhood Illness (IMCI) treatment algorithms have proved, when used correctly, to improve quality of care, reduce the cost of treatment, and reduce under-5 mortality. However, the actual impact of IMCI worldwide has been less than anticipated due to limited uptake of the intervention, and poor adherence to algorithms by clinicians. A recent study in Tanzania showed poor adherence to the IMCI protocols, resulting to low quality of care. Indeed 99% of the children attending outpatient clinics with fever who tested negative for malaria were prescribed antibiotics, although this was appropriate in less than 20%. Such procedures lead to poor health outcomes, huge wastage of drugs and rapid spread of bacterial resistance.The rapidly changing patterns of disease and drug resistance of microorganisms, the poor adherence to clinical guidelines using paper based algorithms and the increasing availability of new technologies for more accurate diagnostics and better adherence to evidence based clinical algorithms are the basis of this project. We will test whether the technologies that are available today can be used to improve the quality of care that is being provided to Tanzanian children through the use of electronic decision support to promote evidence-based medicine and the use of rapid diagnostic tests which promote the rational use of drugs.In particular, we expect to show that it is feasible and cost effective to- Revise standardized diagnostic and treatment procedures for the management of childhood illness (IMCI) incorporating more sophisticated clinical algorithms based on current evidence about disease patterns and drug resistance; - Rapidly incorporate these changes into case management algorithms in an electronic format that is accurately used; - Demonstrate improved clinical and cost effectiveness of electronic algorithms when compared to the used of paper based IMCI algorithms leading to a reduction in the inappropriate use of antibiotics and antimalarials for children with fever, and therefore improve the quality of care that is being provided to children in Tanzania.Methodology:Phase 1: Preparatory phase (9 months) will include microbiological analysis of children between 2 months an 5 years of age with febrile illness from two sites in Tanzania using samples and clinical data that have already been collected prior to this project. This analysis will form the basis for new IMCI guidelines.Phase 2: Study Phase (24 months) will be a randomized control study of the implementation and use of IMCI protocols for the assessment and treatment of children 2 months-5 years of age with fever. It will compare the results of 3 treatment arms (health facility being the randomization unit):a) training and use of new IMCI algorithms for fever using paper decision chartsb) training and use of new IMCI algorithms for fever using electronic algorithmsc) control: old IMCI algorithms on paper charts (or usual procedures) Phase 3: Analysis and writing (6 months)Expected outcomeWe expect to show that the use of decision support systems using mobile technology will enhance the ability to improve and rapidly implement evidence based clinical algorithms by improving adherence of health workers to these improved algorithms, leading to better health outcomes and more rational use of antimalarial drugs and antibiotics, when compared to paper-based decision charts or usual health facility procedures.
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