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

Amani Flexson Shao, Clotilde Rambaud-Althaus, Josephine Samaka, Allen Festo Faustine, Seneca Perri-Moore, Ndeniria Swai, Judith Kahama-Maro, Marc Mitchell, Blaise Genton, Valérie D'Acremont, Amani Flexson Shao, Clotilde Rambaud-Althaus, Josephine Samaka, Allen Festo Faustine, Seneca Perri-Moore, Ndeniria Swai, Judith Kahama-Maro, Marc Mitchell, Blaise Genton, Valérie D'Acremont

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Trial registration: Pan African Clinical Trials Registry PACTR201011000262218.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Distribution of diagnoses at inclusion…
Fig 1. Distribution of diagnoses at inclusion in the ALMANACH (A) and standard practice (B) arms.
* Diagnosis given by clinicians when they do not classify further the respiratory infection.
Fig 2. Study profile.
Fig 2. Study profile.

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