ehealth digital library

Digital library of
the Tanzania
health
community

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

Shao, A. F., Rambaud-Althaus, C., Samaka, J., Faustine, A. F., Perri-Moore, S., Swai, N., Kahama-Maro, J., Mitchell, M., Genton, B. and D'Acremont, V. (2015) New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania. PloS one, 10 (7). e0132316. ISSN 1932-6203

[img]
Preview
PDF
Amani_Flexson_Shao.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial.

Download (864kB)

Abstract

The decline of malaria and scale-up of rapid diagnostic tests calls for a revision of IMCI. A new algorithm (ALMANACH) running on mobile technology was developed based on the latest evidence. The objective was to ensure that ALMANACH was safe, while keeping a low rate of antibiotic prescription. Consecutive children aged 2-59 months with acute illness were managed using ALMANACH (2 intervention facilities), or standard practice (2 control facilities) in Tanzania. Primary outcomes were proportion of children cured at day 7 and who received antibiotics on day 0. 130/842 (15∙4%) in ALMANACH and 241/623 (38∙7%) in control arm were diagnosed with an infection in need for antibiotic, while 3∙8% and 9∙6% had malaria. 815/838 (97∙3%;96∙1-98.4%) were cured at D7 using ALMANACH versus 573/623 (92∙0%;89∙8-94∙1%) using standard practice (p<0∙001). Of 23 children not cured at D7 using ALMANACH, 44% had skin problems, 30% pneumonia, 26% upper respiratory infection and 13% likely viral infection at D0. Secondary hospitalization occurred for one child using ALMANACH and one who eventually died using standard practice. At D0, antibiotics were prescribed to 15∙4% (12∙9-17∙9%) using ALMANACH versus 84∙3% (81∙4-87∙1%) using standard practice (p<0∙001). 2∙3% (1∙3-3.3) versus 3∙2% (1∙8-4∙6%) received an antibiotic secondarily. Management of children using ALMANACH improve clinical outcome and reduce antibiotic prescription by 80%. This was achieved through more accurate diagnoses and hence better identification of children in need of antibiotic treatment or not. The building on mobile technology allows easy access and rapid update of the decision chart.

Item Type: Article
Keywords: ALMANACH, Malaria, Rapid Diagnostic Tests, Antibiotic, Tanzania
Subjects: Malaria > Diagnosis & treatment
Divisions: National Institute for Medical Research
Depositing User: Mr Joseph Madata
Date Deposited: 22 Jul 2015 09:36
Last Modified: 22 Jul 2015 09:36
URI: http://ihi.eprints.org/id/eprint/3294

Actions (login required)

Edit Item Edit Item

Downloads

Downloads per month over past year

View more statistics