ArticlePloS one2019
Results from one-year use of an electronic Clinical Decision Support System in a post-conflict context: An implementation research.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Implementation, adoption and impact of clinical decision support system for antibiotic prescribing in primary care: a systematic review.The Journal of antimicrobial chemotherapy · 2026Pooled it
- Pooled it
- 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
- Digital innovations and health information systems: Lessons learned from implementing ALMANACH in Nigeria.PLOS digital health · 2026Article
- A Systematic Review of Factors Affecting Utilization of Decision Support Systems: The Interplay Between Technology, Users, and the Healthcare Environment.Health science reports · 2026Review
- 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
- Enhancing quality of health care delivered to under 5 children in Kibra informal settlement of Nairobi, Kenya, by using mHealth platform with electronic clinical decision support system.Oxford open digital health · 2025Article
- Article
- Electronic Clinical Decision Support Tools: Strategies to Improve the Management of Lower Respiratory Tract Infections in Low-Resource Settings.The American journal of tropical medicine and hygiene · 2024Article
- A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study).PLOS digital health · 2024Article
- Potential for an Electronic Clinical Decision Support Tool to Support Appropriate Antibiotic Use for Pediatric Diarrhea Among Village Doctors in Bangladesh.Journal of the Pediatric Infectious Diseases Society · 2024Article
- Observational
- 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
- Impact of digital clinical decision support on quality of care and antibiotic stewardship for children under five in South-Central Somalia.Oxford open digital health · 2024Article
- Antimicrobial stewardship in primary health care programs in humanitarian settings: the time to act is now.Antimicrobial resistance and infection control · 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
- Primary healthcare delivery models in African conflict-affected settings: a systematic review.Conflict and health · 2023Review
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn 2017, the Adamawa State Primary Healthcare Development Agency introduced ALMANACH, an electronic clinical decision support system based on a modified version of IMCI. The target area was the Federal State of Adamawa (Nigeria), a region recovering after the Boko Haram insurgency. The aim of this implementation research was to assess the improvement in terms of quality care offered after one year of utilization of the tool.
methodsWe carried out two cross-sectional studies in six Primary Health Care Centres to assess the improvements in comparison with the baseline carried out before the implementation. One survey was carried out inside the consultation room and was based on the direct observation of 235 consultations of children aged from 2 to 59 months old. The second survey questioned 189 caregivers outside the health facility for their opinion about the consultation carried out through using the tablet, the prescriptions and medications given.
resultsIn comparison with the baseline, more children were checked for danger signs (60.0% vs. 37.1% at baseline) and in addition, children were actually weighed (61.1% vs. 27.7%) during consultation. Malnutrition screening was performed in 35.1% of children (vs. 12.1%). Through ALMANACH, also performance of preventive measures was significantly improved (p<0.01): vaccination status was checked in 39.8% of cases (vs. 10.6% at baseline), and deworming and vitamin A prescription was increased to 46.5% (vs. 0.7%) and 48.3% (vs. 2.8%) respectively. Furthermore, children received a complete physical examination (58.3% vs. 45.5%, p<0.01) and correct treatment (48.4% vs. 29.5%, p<0.01). Regarding antibiotic prescription, 69.3% patients received at least one antibiotic (baseline 77.7%, p<0.05).
conclusionsOur findings highlight major improvements in terms of quality of care despite many questions still pending to be answered in relation to a full integration of the tool in the Adamawa health system.
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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.