ArticleThe American journal of tropical medicine and hygiene2017
Performance of Health Workers Using an Electronic Algorithm for the Management of Childhood Illness in Tanzania: A Pilot Implementation Study.
Article in The American journal of tropical medicine and hygiene, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
31 citing papers in PubMed, 3 syntheses or guidelines pooled 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
- Community health worker-based mobile health (mHealth) approaches for improving management and caregiver knowledge of common childhood infections: A systematic review.Journal of global health · 2020Pooled it
- How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review.BMJ global health · 2020Pooled it
- Adherence to smartphone-delivered antimicrobial prescribing guidelines in hospitals in Lao PDR: A stepped-wedge cluster randomized controlled trial.PLoS medicine · 2026Trial
- Effectiveness of a clinical decision support algorithm (CDSA) on reducing unnecessary antibiotic prescriptions for upper respiratory tract infections among ambulatory HIV-infected adults in Mozambique: a cluster randomized controlled trial.BMC infectious diseases · 2026Trial
- Trial
- A digital health algorithm to guide antibiotic prescription in pediatric outpatient care: a cluster randomized controlled trial.Nature medicine · 2024Trial
- The Effect of Text Message Reminders to Health Workers on Quality of Care for Malaria, Pneumonia, and Diarrhea in Malawi: A Cluster-Randomized, Controlled Trial.The American journal of tropical medicine and hygiene · 2019Trial
- 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
- De-implementation of unnecessary antibiotic use for upper respiratory tract infections in ambulatory HIV care in Mozambique: a two-arm parallel cluster-randomized controlled hybrid type II trial.Implementation science communications · 2026Article
- Knowledge of pulse oximetry, indications for oxygen therapy, and integrated management of childhood illness among health care workers in Nigerian primary and secondary health facilities: a cross-sectional survey.Frontiers in public health · 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
- Article
- A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study).PLOS digital health · 2024Article
- Information and Communication Technology to Enhance the Implementation of the Integrated Management of Childhood Illness: A Systematic Review and Meta-Analysis.Mayo Clinic proceedings. Digital health · 2024Review
- De-implementation strategy to reduce unnecessary antibiotic prescriptions for ambulatory HIV-infected patients with upper respiratory tract infections in Mozambique: a study protocol of a cluster randomized controlled trial.Implementation science : IS · 2024Article
- A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications.Medicina (Kaunas, Lithuania) · 2023Review
- A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance.Antibiotics (Basel, Switzerland) · 2023Article
- Digitalizing Clinical Guidelines: Experiences in the Development of Clinical Decision Support Algorithms for Management of Childhood Illness in Resource-Constrained Settings.Global health, science and practice · 2023Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In low-resource settings, where qualified health workers (HWs) are scarce and childhood mortality high, rational antimicrobial prescription for childhood illnesses is a challenge. To assess whether smartphones running guidelines, as compared with paper support, improve consultation process and rational use of medicines for children, a pilot cluster-randomized controlled study was conducted in Tanzania. Nine primary health-care facilities (HFs) were randomized into three arms: 1) paper algorithm, 2) electronic algorithm on a smartphone, and 3) control. All HWs attending children aged 2-59 months for acute illness in intervention HFs were trained on a new clinical algorithm for management of childhood illness (ALMANACH) either on 1) paper or 2) electronic support; 4 months after training, consultations were observed. An expert consultation was the reference for classification and treatment. Main outcomes were proportion of children checked for danger signs, and antibiotics prescription rate. A total of 504 consultations (166, 171, and 167 in control, paper, and phone arms, respectively) were observed. The use of smartphones versus paper was associated with a significant increase in children checked for danger signs (41% versus 74%, P = 0.04). Antibiotic prescriptions rate dropped from 70% in the control to 26%, and 25% in paper and electronic arms. The HWs-expert agreement on pneumonia classification remained low (expert's pneumonia identified by HWs in 26%, 30%, and 39% of patients, respectively).Mobile technology in low-income countries is implementable and has a potential to improve HWs' performance. Additional point-of-care diagnostic tests are needed to ensure appropriate management. Improving the rational use of antimicrobial is a challenge that ALMANACH can help to take up.
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