New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania.

Détails

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Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_49F3210B31FE
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania.
Périodique
Plos One
Auteur(s)
Shao A.F., Rambaud-Althaus C., Samaka J., Faustine A.F., Perri-Moore S., Swai N., Kahama-Maro J., Mitchell M., Genton B., D'Acremont V.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
10
Numéro
7
Pages
e0132316
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't Publication Status: epublish
Résumé
INTRODUCTION: The 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.
METHODS: Consecutive 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.
RESULTS: 130/842 (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.
CONCLUSION: Management 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 REGISTRATION: Pan African Clinical Trials Registry PACTR201011000262218.
Mots-clé
Anti-Bacterial Agents/therapeutic use, Child, Preschool, Disease Management, Electronic Health Records, Female, Humans, Infant, Male, Pneumonia, Bacterial/diagnosis, Pneumonia, Bacterial/drug therapy, Skin Diseases, Bacterial/diagnosis, Skin Diseases, Bacterial/drug therapy, Smartphone, Treatment Outcome
Pubmed
Web of science
Open Access
Oui
Création de la notice
24/08/2015 17:41
Dernière modification de la notice
20/08/2019 14:57
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