Trial reportThe Lancet. Digital health2020
Electronic decision support and diarrhoeal disease guideline adherence (mHDM): a cluster randomised controlled trial.
Trial report in The Lancet. Digital health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03154229 (The Evaluation of a mHealth Platform for Diarrheal Disease Decision-support in Hospitals), which is not on this map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
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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.
The Evaluation of a mHealth Platform for Diarrheal Disease Decision-support in Hospitals: a Cluster Randomized Controlled Trial
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Decision-support tools via mobile devices to improve quality of care in primary healthcare settings.The Cochrane database of systematic reviews · 2021Pooled it
- 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
- Comparison of a Rapid Multiplex Gastrointestinal Panel with Standard Laboratory Testing in the Management of Children with Hematochezia in a Pediatric Emergency Department: Randomized Controlled Trial.Microbiology spectrum · 2023Trial
- Improving Antibiotic Stewardship for Diarrheal Disease With Probability-Based Electronic Clinical Decision Support: A Randomized Crossover Trial.JAMA pediatrics · 2022Trial
- Ranked Placement of Phage Predation as a Determinant of Dehydration Severity Among Cholera Patients in Bangladesh.The Journal of infectious diseases · 2026Article
- Molecular Methods to DetectmedRxiv : the preprint server for health sciences · 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
- Cholera rapid diagnostic tests at the host-microbe interface: Key Considerations for Global Deployments.medRxiv : the preprint server for health sciences · 2025Article
- Assembly and performance of a cholera RDT prototype that detects bothJournal of clinical microbiology · 2025Article
- Article
- Etiology of Severely Dehydrating Diarrheal Illness in Infants and Young Children Residing in Low- and Middle-Income Countries.Open forum infectious diseases · 2024Article
- Phage predation, disease severity and pathogen genetic diversity in cholera patients.bioRxiv : the preprint server for biology · 2024Article
- Qualitative Assessment of a Smartphone-Based Mobile Health Tool to Guide Diarrhea Management in Bangladesh.The American journal of tropical medicine and hygiene · 2024Article
- A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study.The Lancet. Global health · 2023Observational
- Understanding variations in diarrhea management across healthcare facilities in Bangladesh: a formative qualitative study.Journal of infection in developing countries · 2023Article
- Genome-wide association studies reveal distinct genetic correlates and increased heritability of antimicrobial resistance inMicrobial genomics · 2022Article
- Diagnosis, Management, and Future Control of Cholera.Clinical microbiology reviews · 2022Review
- Observational
- Introduction of an Electronic Clinical Decision Support Tool to Inform Prescribing for Pediatric Diarrhea in Bangladesh and Mali: Do Provider Expectations Predict Experiences?The American journal of tropical medicine and hygiene · 2022Article
Corrections and comments
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Authors and funding
23 authors.
Funding
Abstract
backgroundAcute diarrhoeal disease management often requires rehydration alone without antibiotics. However, non-indicated antibiotics are frequently ordered and this is an important driver of antimicrobial resistance. The mHealth Diarrhoea Management (mHDM) trial aimed to establish whether electronic decision support improves rehydration and antibiotic guideline adherence in resource-limited settings.
methodsA cluster randomised controlled trial was done at ten district hospitals in Bangladesh. Inclusion criteria were patients aged 2 months or older with uncomplicated acute diarrhoea. Admission orders were observed without intervention in the pre-intervention period, followed by randomisation to electronic (rehydration calculator) or paper formatted WHO guidelines for the intervention period. The primary outcome was rate of intravenous fluid ordered as a binary variable. Generalised linear mixed-effect models, accounting for hospital clustering, served as the analytical framework; the analysis was intention to treat. The trial is registered with ClinicalTrials.gov (NCT03154229) and is completed.
findingsFrom March 11 to Sept 10, 2018, 4975 patients (75·6%) of 6577 screened patients were enrolled. The intervention effect for the primary outcome showed no significant differences in rates of intravenous fluids ordered as a function of decision-support type. Intravenous fluid orders decreased by 0·9 percentage points for paper electronic decision support and 4·2 percentage points for electronic decision support, with a 4·2-point difference between decision-support types in the intervention period (paper 98·7% [95% CI 91·8-99·8] vs electronic 94·5% [72·2-99·1]; p
interpretationAlthough intravenous fluid orders did not change, electronic decision support was associated with increases in the volume of intravenous fluid ordered and decreases in antibiotics ordered, which are consistent with WHO guidelines.
fundingUS National Institutes of Health.
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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.