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