Trial reportPloS one2015
New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania.
Trial report in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 73 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Dynamic Clinical Decision Support Algorithms to Manage Sick Children in Primary Health Care Settings in Rwanda
Dynamic Clinical Decision Support Algorithms to Manage Sick Children in Primary Health Care Settings in Tanzania
Using the CRP Test in Children Under 12 Years With Respiratory Symptoms in Kyrgyz Republic
Multidisciplinary Surveillance and Investigation of Febrile Illness in Guinea
Who cites it
73 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Impact of Antimicrobial Stewardship in Children in Low- and Middle-income Countries: A Systematic Review.The Pediatric infectious disease journal · 2022Pooled it
- Behavioural interventions to address rational use of antibiotics in outpatient settings of low-income and lower-middle-income countries.Tropical medicine & international health : TM & IH · 2021Pooled it
- Trial
- Electronic Integrated Management of Childhood Illness (eIMCI): a randomized controlled trial to evaluate an electronic clinical decision-making support system for management of sick children in primary health care facilities in South Africa.BMC health services research · 2024Trial
- A digital health algorithm to guide antibiotic prescription in pediatric outpatient care: a cluster randomized controlled trial.Nature medicine · 2024Trial
- A Randomized Trial to Assess the Impact of a Package of Diagnostic Tools and Diagnostic Algorithm on Antibiotic Prescriptions for the Management of Febrile Illnesses Among Children and Adolescents in Primary Health Facilities in Burkina Faso.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- An Integrated eDiagnosis Approach (IeDA) versus standard IMCI for assessing and managing childhood illness in Burkina Faso: a stepped-wedge cluster randomised trial.BMC health services research · 2021Trial
- Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting?BMC pediatrics · 2020Trial
- Trial
- Diagnosis of Persistent Fever in the Tropics: Set of Standard Operating Procedures Used in the NIDIAG Febrile Syndrome Study.PLoS neglected tropical diseases · 2016Trial
- Antibiotic overuse as a modifiable early-life risk factor for non-communicable diseases in sub-Saharan Africa.Global health action · 2026Article
- Defining a target product profile for antimicrobials to treat severe paediatric bacterial enteric infections in low- and medium-income countries, caused byJAC-antimicrobial resistance · 2026Review
- The impact of interventions to modify antibiotic use in children with suspected infections in ambulatory healthcare settings in LMICs: a systematic review.JAC-antimicrobial resistance · 2026Review
- Article
- Improving antibiotic prescribing in LMICs: Insights from an outpatient clinic in Pakistan.New microbes and new infections · 2026Article
- Antibiotic stewardship and point-of-care testing for children in 25 low-income and lower-middle-income countries: a systematic review and meta-analysis.EClinicalMedicine · 2025Article
- Article
- medAL-suite: A software solution for creating and deploying complex clinical decision support algorithms.BMC medical informatics and decision making · 2025Article
- Article
- Development and implementation of a digital clinical decision support system to increase the quality of primary healthcare delivery in a refugee setting in Chad.BMC primary care · 2025Article
13 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe 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.
methodsConsecutive 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.
results130/842 (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.
conclusionManagement 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 registrationPan African Clinical Trials Registry PACTR201011000262218.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.