A mixed methods protocol to evaluate the effect and cost-effectiveness of an Integrated electronic Diagnosis Approach (IeDA) for the management of childhood illnesses at primary health facilities in Burkina Faso

Karl Blanchet, James J Lewis, Francisco Pozo-Martin, Arsene Satouro, Serge Somda, Patrick Ilboudo, Sophie Sarrassat, Simon Cousens, Karl Blanchet, James J Lewis, Francisco Pozo-Martin, Arsene Satouro, Serge Somda, Patrick Ilboudo, Sophie Sarrassat, Simon Cousens

Abstract

Background: Burkina Faso introduced the Integrated Management of Childhood Illnesses (IMCI) strategy in 2003. However, an evaluation conducted in 2013 found that only 28 % of children were assessed for three danger signs as recommended by IMCI, and only 15 % of children were correctly classified. About 30 % of children were correctly prescribed with an antibiotic for suspected pneumonia or oral rehydration salts (ORS) for diarrhoea, and 40 % were correctly referred. Recent advances in information and communication technologies (ICT) and use of electronic clinical protocols hold the potential to transform healthcare delivery in low-income countries. However, no evidence is available on the effect of ICT on adherence to IMCI. This paper describes the research protocol of a mixed methods study that aims to measure the effect of the Integrated electronic Diagnosis Approach innovation (an electronic IMCI protocol provided to nurses) in two regions of Burkina Faso.

Methods/design: The study combines a stepped-wedge trial, a realistic evaluation and an economic study in order to capture the effect of the innovation after its introduction on the level of adherence, cost and acceptability.

Discussion: The main challenge is to interconnect the three substudies. In integrating outcome, process and cost data, we focus on three key questions: (i) How does the effectiveness and the cost of the intervention vary by type of health worker and type of health centre? (ii) What is the impact of changes in the content, coverage and quality of the IeDA intervention on adherence and cost-effectiveness? (iii) What mechanisms of change (including costs) might explain the relationship between the IeDA intervention and adherence?

Trial registration: Clinicaltrials.gov, NCT02341469 .

Figures

Fig. 1
Fig. 1
Evaluation mixed methods study framework
Fig. 2
Fig. 2
The sequence of districts receiving the intervention after each period of 4 months during the stepped-wedge trial

References

    1. United Nations Inter-agency Group for Child Mortality Estimation, Levels and trends in child mortality—Report 2015. WHO. New York; 2015.
    1. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361(9376):2226–34. doi: 10.1016/S0140-6736(03)13779-8.
    1. Boss LP, Toole MJ, Yip R. Assessments of mortality, morbidity, and nutritional status in Somalia during the 1991-1992 famine. Recommendations for standardization of methods. JAMA. 1994;272(5):371–6. doi: 10.1001/jama.1994.03520050051029.
    1. Rakha M, et al. Does implementation of the IMCI strategy have an impact on child mortality? A retrospective analysis of routine data from Egypt. BMJ Open. 2013;3(1). doi:10.1136/bmjopen-2012-001852.
    1. Nguyen D, et al. Does Integrated Management of Childhood Illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis. PLoS One. 2013;8(6):e66030. doi: 10.1371/journal.pone.0066030.
    1. Jones G, et al. How many child deaths can we prevent this year? Lancet. 2003;362(9377):65–71. doi: 10.1016/S0140-6736(03)13811-1.
    1. Derenzi B, et al. e-IMCI: improving pediatric health care in low-income countries. Proceedings of the 2008 Conference on Human Factors in Computing Systems, CHI 2008. Florence, Italy: April 5-10 2008.
    1. Horwood C, et al. Experiences of training and implementation of the integrated management of childhood illness (IMCI) in South Africa: a qualitative evaluation of the IMCI case management training course. Soc Sci Med. 2009;70(2):313–320. doi: 10.1016/j.socscimed.2009.10.002.
    1. Bryce J, Victora CG, Black RE. The unfinished agenda in child survival. Lancet. 2013. 382(9897): 1049-59.
    1. Chaudhary N, Mohanty P, Sharma M. Integrated management of childhood illness (IMCI) follow-up of basic health workers. Indian J Paediatr. 2005;72(9):735–739. doi: 10.1007/BF02734143.
    1. Rowe A, et al. The rise and fall of supervision in a project designed to strengthen supervision of Integrated Management of Childhood Illness in Benin. Health Policy Plan. 2010;25(2):125–134. doi: 10.1093/heapol/czp054.
    1. Takada S, Oudavong B, Kurolwa C. The successes and challenges of the IMCI training course in Lao PDR. Southeast Asian J Trop Med Public Health. 2007;38(1):178–87.
    1. Mugala N, et al. Barriers to implementation of the HIV guidelines in the IMCI algorithm among IMCI trained health workers in Zambia. BMC Paediatrics. 2010;10(93).
    1. Kouanda L, Baguiya A. Evaluation de la qualite des soins prodigues aux enfants de moins de cinq (05) ans dans les formations sanitaires des regions du nord et du centre-nord du Burkina Faso. Burkina Faso: WHO, UNICEF, UNFPA; 2013.
    1. Peters T. Using cell phones to improve treatment in Cape Town tuberculosis patients: an evaluation. Cape Town: Bridges Organisation; 2005.
    1. Mitchell M, et al. Perceived improvement in integrated management of childhood illness implementation through use of mobile technology: qualitative evidence from a pilot study in Tanzania. J Health Commun. 2012;17(sup1):118–127. doi: 10.1080/10810730.2011.649105.
    1. Chib A, van Velthoven MH, Car J. mHealth adoption in low-resource environments: a review of the use of mobile healthcare in developing countries. J Health Commun. 2015;20(1):4–34. doi: 10.1080/10810730.2013.864735.
    1. DSS/DGISS . Enquete SARA. Ouagadougou, Burkina Faso: Ministere de la Sante; 2012.
    1. Ministere de la Sante . Plan national de developpement sanitaire 2011-2020. Ouagadougou: Ministere de la Sante Burkina Faso; 2011.
    1. Deflaux G. Registre Electronique de Consultations (REC)—cahier des charges. Ouagadougou, Burkina Faso: Terre des Hommes; 2010.
    1. Deflaux G, et al. Computerization of medical consultation for children under five years of age in rural areas of Burkina Faso. In: Bolay J-C et al., editors. Technologies for sustainable development. Swistzerland: Springer; 2014.
    1. Yameogo P, et al. REC: Résultats d’utilisation d’un logiciel informatique pendant la consultation des enfants de moins de 5 ans selon la stratégie PCIME. Burkina Faso: Terre des hommes; 2011.
    1. Beard E, et al. Stepped wedge randomised controlled trials: systematic review of studies published between 2010 and 2014. Trials. 2015;16(1):1–14. doi: 10.1186/1745-6215-16-1.
    1. Hargreaves JR, et al. Five questions to consider before conducting a stepped wedge trial. Trials. 2015;16(1):1–4. doi: 10.1186/1745-6215-16-1.
    1. Rowe AK, et al. A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin. Am J Public Health. 2009;99(5):837–46. doi: 10.2105/AJPH.2008.134411.
    1. Rowe AK, et al. Evaluating health worker performance in Benin using the simulated client method with real children. Implement Sci. 2012;7:95. doi: 10.1186/1748-5908-7-95.
    1. Horwood C, et al. An evaluation of the quality of IMCI assessments among IMCI trained health workers in South Africa. PLoS One. 2009;4(6):e5937. doi: 10.1371/journal.pone.0005937.
    1. Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials. 2007;28(2):182–91. doi: 10.1016/j.cct.2006.05.007.
    1. Copas AJ, et al. Designing a stepped wedge trial: three main designs, carry-over effects and randomisation approaches. Trials. 2015;16(1):1–12. doi: 10.1186/s13063-015-0842-7.
    1. World Health Organisation, Service Availability and Readiness Assessment (SARA): an annual monitoring system for service delivery - Reference Manual . Service availability and readiness assessment (SARA): an annual monitoring system for service delivery—reference manual. Geneva: Health Statistics and Information Systems, WHO; 2013.
    1. Davey C, et al. Analysis and reporting of stepped wedge randomised controlled trials: synthesis and critical appraisal of published studies, 2010 to 2014. Trials. 2015;16:358. doi: 10.1186/s13063-015-0838-3.
    1. Drummond, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 2015.
    1. Johns BEA. Programme costs in the economic evaluation of health interventions. Cost Effectiveness Resour Allocation. 2003;1(1):1–10.
    1. Pawson R, Tilley N. Realistic evaluation. Third. London: Sage Publications; 1997.
    1. Yin R. Case study research: design and methods. London: Sage Publications; 2003.
    1. Blanchet K, James P. How to do (or not to do)…a social network analysis in health systems research. Health Policy Plan. 2012;27:438–446. doi: 10.1093/heapol/czr055.
    1. Blanchet K, James P. The role of social networks in the governance of health systems: the case of eye care systems in Ghana. Health Policy Plan. 2013;28(2):143–56. doi: 10.1093/heapol/czs031.
    1. Yin R. Case study research: design and methods. London: Sage Publications; 2003.
    1. Trochim W. Outcome pattern matching and program theory. Eval Program Plan. 1989;12:355–366. doi: 10.1016/0149-7189(89)90052-9.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi