Lessons from the field: implementing an electronic clinical decision support app for acute febrile illness in rural Cambodia.

To improve the management of acute febrile illness in rural low- and middle-income country (LMIC) primary care settings, we developed the Electronic clinical Decision support for Acute fever Management (EDAM) app and evaluated it through a cluster-randomised trial in rural Cambodian primary health centres (PHCs). In parallel, we conducted structured, mixed methods observations at a subset of participating PHCs to document key challenges in screening, enrolling and managing patients. A key lesson was the critical importance of user-centred design to align digital tools with health worker workflows and capabilities. The lessons from these observations may help guide researchers and policymakers developing novel digital health solutions for low- and semi-skilled health workers in rural LMIC settings. Our experiences could offer valuable insights, as there are few documented digital health interventions designed for these contexts. Furthermore, navigating the challenges of implementation and subsequent evaluation remains a significant hurdle for the field.