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Electronic algorithms based on host biomarkers Point of Care Tests to decide on admission and antibiotic prescription in Tanzanian febrile children (e-POCT project)

English title Electronic algorithms based on host biomarkers Point of Care Tests to decide on admission and antibiotic prescription in Tanzanian febrile children (e-POCT project)
Applicant D'Acremont Valérie
Number 146896
Funding scheme r4d (Swiss Programme for Research on Global Issues for Development)
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 01.01.2014 - 30.06.2017
Approved amount 438'143.00
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Keywords (9)

developing countries; electronic algorithms; fever; host biomarkers; malaria; pneumonia; oximetry; children; integrated management

Lay Summary (French)

Lead
Les professionnels de santé dans les pays en développement ont des mal à identifier les enfants à risque de mourir et ceux qui ont besoin d'antibiotiques, en raison de leurs compétences cliniques limitées, de l'indisponibilité des tests de diagnostic, et de leur manque d’adhérence aux recommandations. La mortalité des enfants dans ces pays est donc supérieure à ce qu'elle devrait être et beaucoup trop de médicaments antimicrobiens sont prescrits.
Lay summary

Contenu et objectifs du travail de recherche

Pour améliorer la prise en charge des enfants fébriles, nous avons conçu une nouvelle approche basée non pas sur des tests détectant les microorganismes mais sur de nouveaux tests mesurant des facteurs reflétant la réaction du corps du patient à l’infection (plutôt que l’infection elle-même), qui ont donc l’avantage de pouvoir distinguer entre maladie significative (nécessitant un traitement et/ou une prise en charge à l’hôpital) et bénigne. Les résultats de ces nouveaux tests rapides sont combinés à quelques signes cliniques clés sous forme d’arbre décisionnel construit sur un support électronique (tablette Android). Le premier objectif de l'étude est d'évaluer l'innocuité de cette nouvelle approche, en comparant le taux de guérison des enfants pris en charge avec cet outil et celui des enfants pris en charge comme d’habitude. Le second objectif est d’évaluer l’impact sur la prescription d’antimalariques et d’antibiotiques et sur le triage des enfants sévères nécessitant une hospitalisation.

Contexte scientifique et social du projet de recherche

Le développement d'un tel outil devrait permettre de diminuer la mortalité due à l'admission retardée tout en limitant l'utilisation irrationnelle des antimicrobiens, et par conséquent l'émergence de résistances qui représente l'une des menaces de santé publique les plus importantes dans le monde actuellement. Ce projet a un grand potentiel d'application car il combine les connaissances les plus récentes sur les performances diagnosticques réelles des éléments cliniques et des technologies simples pouvant être utilisées au lit du malade, dans les centres de soins primaires des pays à ressources limitées.

Direct link to Lay Summary Last update: 30.10.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
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 Kristina, Kagoro Frank, Samaka Josephine, Masimba John, Saib Zamzam, Temba Hosiana, Mlaganile Tarsis, Sangu Willy, Rambaud-Althaus Clotilde, Gervaix Alain, Genton Blaise, D'Acremont Valérie, 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, in Plos Medicine.

Collaboration

Group / person Country
Types of collaboration
Biomérieux,Medical Affairs Department, Dr. Patricia de Saint Jean France (Europe)
- Industry/business/other use-inspired collaboration
University of Toronto, Prof. Kevin Kain Canada (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Service d'Accueil et d'Urgences Pédiatriques, Hôpitaux Universitaires de Genève, Prof. Alain Gervaix Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Symposium on Antimicrobial Resistance Individual talk e-POCT: Innovative Point-of-care technologies for management of febrile Tanzanian children attending primary care facilities 28.04.2017 Dar es Salaam, Tanzania D'Acremont Valérie;
American Society of Tropical Medicine and Hygiene Annual Conference Individual talk Using point-of-care C-reactive protein test results to target antibiotic prescription for respiratory illnesses in under-fives: experience from a clinical trial in Dar es Salaam, Tanzania 16.11.2016 Atlanta, United States of America D'Acremont Valérie;
American Society of Tropical Medicine and Hygiene Annual Conference Poster A novel electronic algorithm using host biomarker point-of-care-tests for management of fever in under-fives in resource-poor settings (e-POCT): a controlled, non-inferiority study 14.11.2016 Atlanta, United States of America D'Acremont Valérie;


Self-organised

Title Date Place
Scientific dissemination meeting 22.09.2017 Dar es Salaam, Tanzania

Knowledge transfer events



Self-organised

Title Date Place
Plusieurs dissemination meetings of the e-POCT project 25.04.2017 Dar es Salaam, Tanzania

Communication with the public

Communication Title Media Place Year
Media relations: print media, online media I am not only a diagnostic machine TED x Talks, en live au SwissTech Convention Centre de l'EPFL et diffusé sur Youtube International 2014

Awards

Title Year
Dr Keitel has received the Young Investigator Award for her oral presentation at the ASTMH International conference 2016
Dr. D'Acremont has received the Pfizer Research Prize 2015 (http://www.pfizerforschungspreis.ch/index.php/fr/les-laureates/2015.html) 2015
Dr. Keitel has received an Early Career Award Program Grant from the Thrasher Research Fund to conduct the ePOCT clinical trial 2014

Abstract

Health professionals in developing countries have limited ability to identify children at risk of dying and those in need of antibiotics. The main reasons are limited clinical skills and time, unavailability of diagnostic tests (laboratory or x-ray) and non-adherence to practice guidelines. Child mortality is therefore higher than it should be. Etiological diagnostic tests (detecting microorganisms) may not always help since the distinction between infection and disease and between mild or severe disease is not straightforward. Overprescription of antibiotics is therefore widespread and leads to the development of drug resistance. To address these challenges, decision charts for the management of febrile illness will be developed and include i) few clinical parameters simple to assess, and ii) POCTs results based on specific host markers that can discriminate between mild and severe disease, pneumonia and upper respiratory tract infections, and unspecified fevers of bacterial and of viral origin. This algorithm combining clinical and bedside laboratory tests will be built on an electronic support (android tablet). The first objective of the study is to assess the safety of this new electronic decision trees that integrate simple clinical assessment and POCTs results (oxygen saturation and a combination of specific host biomarkers) as a triage tool to decide on admitting febrile children; the second objective is to assess the usefulness and safety of this new electronic decision trees that integrate simple clinical assessment and POCT results (combination of specific host biomarkers) as decision-making tool to prescribe antibiotics to non-severe febrile children. The development of such a tool will decrease mortality due to delayed admission, At the same time, it will decrease irrational use of antibiotics, and hence drug pressure and emergence of drug resistance, which represents one of the most important public health threats our world is facing today. This project has the potential of huge applicability since it is specifically designed for end-users with limited medical skills and low resources, as it is the case in most areas of developing countries.
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