Using an eIMCI-Derived Decision Support Protocol to Improve Provider-Caretaker Communication for Treatment of Children Under 5 in Tanzania

Abstract

In Tanzania, significant effort has been made to reduce under-5 mortality rates, and has been somewhat successful in recent years. Many factors have contributed to this, such as using standard treatment protocols for sick children. Using mobile technology has become increasingly popular in health care delivery. This study examines whether the use of mobile technology can leverage a standardized treatment protocol to improve the impact of counseling for children's caretakers and result in better understanding of what needs to be done at home after the clinical visit. A randomized cluster design was utilized in clinics in Dar es Salaam, Tanzania. Children were treated using either test electronic protocols (eIMCI) or control paper (pIMCI) protocols. Providers using the eIMCI protocol were shown to counsel the mother significantly more frequently than providers using the pIMCI protocol. Caretakers receiving care by providers using the eIMCI protocol recalled significantly more problems and advice when to return and medications than those receiving care by providers using the pIMCI protocol. There was no significant difference among caretakers regarding the frequency and duration to administer medications. This study indicates the use of mobile technology as an important aide in increasing the delivery and recall of counseling messages.

Keywords: Caretaker education; Communication; Decision support; Health literacy; mHealth.

Figures

Figure 1

Communication Key Information Points

Figure 2

Provider Verbalization of Communication Prompts

Figure 3

Caretaker Recall of Key Information Points