Research Partnerships with Developing Countries
A Programme funded by Swiss National Science Foundation (SNSF) and Swiss Agency for Development and Cooperation (SDC)
Improving quality of health care for Tanzanian children: Assessing the use of electronic decision support to promote evidence-based medicine and rational use of drugs
Improving quality of health care for Tanzanian children: Assessing the use of electronic decision support to promote evidence-based medicine and rational use of drugs (PeDiAtrick) Summary Nearly 10 million children die each year before the age of 5 despite the fact that effective low-cost interventions are available. Integrated Management of Childhood Illness (IMCI) treatment algorithms have proved, when used correctly, to improve quality of care, reduce the cost of treatment, and reduce under-5 mortality. However, the actual impact of IMCI worldwide has been less than anticipated due to limited uptake of the intervention, and poor adherence to algorithms by clinicians. A recent study in Tanzania showed poor adherence to the IMCI protocols, resulting to low quality of care. Indeed 99% of the children attending outpatient clinics with fever who tested negative for malaria were prescribed antibiotics, although this was appropriate in less than 20%. Such procedures lead to poor health outcomes, huge wastage of drugs and rapid spread of bacterial resistance. The rapidly changing patterns of disease and drug resistance of microorganisms, the poor adherence to clinical guidelines using paper based algorithms and the increasing availability of new technologies for more accurate diagnostics and better adherence to evidence based clinical algorithms are the basis of this project. We will test whether the technologies that are available today can be used to improve the quality of care that is being provided to Tanzanian children through the use of electronic decision support to promote evidence-based medicine and the use of rapid diagnostic tests which promote the rational use of drugs. In particular, we expect to show that it is feasible and cost effective to " Revise standardized diagnostic and treatment procedures for the management of childhood illness (IMCI) incorporating more sophisticated clinical algorithms based on current evidence about disease patterns and drug resistance; " Rapidly incorporate these changes into case management algorithms in an electronic format that is accurately used; " Demonstrate improved clinical and cost effectiveness of electronic algorithms when compared to the used of paper based IMCI algorithms leading to a reduction in the inappropriate use of antibiotics and antimalarials for children with fever, and therefore improve the quality of care that is being provided to children in Tanzania. We expect to show that the use of decision support systems using mobile technology will enhance the ability to improve and rapidly implement evidence based clinical algorithms by improving adherence of health workers to these improved algorithms, leading to better health outcomes and more rational use of antimalarial drugs and antibiotics, when compared to paper-based decision charts or usual health facility procedures.
Contact Addresses:
Blaise Genton
Department of Epidemiology and Public Health
Swiss Tropical and Public Health Institute
Socinstrasse 57
CH-4051 Basel
Hassan Mshinda
Ifakara Health Institute
Kiko Avenue
P.O. Box 78373
TZ- Dar es Salaam
Tanzania