Person:

Mitchell, Marc

Background: Poor adherence to the Integrated Management of Childhood Illness (IMCI) protocol reduces the potential impact on under-five morbidity and mortality. Electronic technology could improve adherence; however there are few studies demonstrating the benefits of such technology in a resource-poor settings. This study estimates the impact of electronic technology on adherence to the IMCI protocols as compared to the current paper-based protocols in Tanzania. Methods: In four districts in Tanzania, 18 clinics were randomly selected for inclusion. At each site, observers documented critical parts of the clinical assessment of children aged 2 months to 5 years. The first set of observations occurred during examination of children using paper-based IMCI (pIMCI) and the next set of observations occurred during examination using the electronic IMCI (eIMCI). Children were re-examined by an IMCI expert and the diagnoses were compared. A total of 1221 children (671 paper, 550 electronic) were observed. Results: For all ten critical IMCI items included in both systems, adherence to the protocol was greater for eIMCI than for pIMCI. The proportion assessed under pIMCI ranged from 61% to 98% compared to 92% to 100% under eIMCI (p < 0.05 for each of the ten assessment items). Conclusions: Use of electronic systems improved the completeness of assessment of children with acute illness in Tanzania. With the before-after nature of the design, potential for temporal confounding is the primary limitation. However, the data collection for both phases occurred over a short period (one month) and so temporal confounding was expected to be minimal. The results suggest that the use of electronic IMCI protocols can improve the completeness and consistency of clinical assessments and future studies will examine the long-term health and health systems impact of eIMCI.

Child mortality is one of the most pressing health concerns almost 10 million children die worldwide each year before reaching their fifth birthday, mostly in low-income countries. To aid overburdened and undertrained health workers the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) have developed clinical guidelines, such as the Integrated Management of Childhood Illness (IMCI) to help with the classification and treatment of common childhood illness. To help with deployment, we have developed an electronic version (e-IMCI) that runs on a PDA. From July to September 2007, we ran a pilot of e-IMCI in southern Tanzania. The system guides health workers step-by-step through the treatment algorithms and automatically calculates drug doses. Our results suggest that electronic implementations of protocols such as IMCI can reduce training time and improve adherence to the protocol. They also highlight several important challenges including varying levels of education, language and expertise, which could be most adequately addressed by implementing novel intelligent user interfaces and systems.