Illness ( IMCI ) protocol in Tanzania

Background: Poor adherence to the Integrated Management of Childhood Illness (IMCI) protocol reduces the potential impact on under-five morbidity and mortality. Electronic technology could improve adherence; however there are few studies demonstrating the benefits of such technology in a resource-poor settings. This study estimates the impact of electronic technology on adherence to the IMCI protocols as compared to the current paper-based protocols in Tanzania. Methods: In four districts in Tanzania, 18 clinics were randomly selected for inclusion. At each site, observers documented critical parts of the clinical assessment of children aged 2 months to 5 years. The first set of observations occurred during examination of children using paper-based IMCI (pIMCI) and the next set of observations occurred during examination using the electronic IMCI (eIMCI). Children were re-examined by an IMCI expert and the diagnoses were compared. A total of 1221 children (671 paper, 550 electronic) were observed. Results: For all ten critical IMCI items included in both systems, adherence to the protocol was greater for eIMCI than for pIMCI. The proportion assessed under pIMCI ranged from 61% to 98% compared to 92% to 100% under eIMCI (p < 0.05 for each of the ten assessment items). Conclusions: Use of electronic systems improved the completeness of assessment of children with acute illness in Tanzania. With the before-after nature of the design, potential for temporal confounding is the primary limitation. However, the data collection for both phases occurred over a short period (one month) and so temporal confounding was expected to be minimal. The results suggest that the use of electronic IMCI protocols can improve the completeness and consistency of clinical assessments and future studies will examine the long-term health and health systems impact of eIMCI. Background There is considerable interest in the use of mobile technology to improve health care in low and middle income countries. However, there has been a relative shortage of evidence demonstrating its impact on health outcomes [1-3]. This study explored whether mobile technology can improve the quality of care in the area of child health and in particular in the delivery of the widely used Integrated Management of Childhood Illness (IMCI) protocol for classifying and treating common causes of death including pneumonia, diarrhoea, malaria, measles, and malnutrition. A multi-country evaluation coordinated by the WHO concluded that IMCI has the potential to improve quality of care, reduce the cost of treatment, and reduce under-5 mortality when used correctly [4-7]. However, despite a worldwide effort, the use and impact * Correspondence: mmitchel@hsph.harvard. edu Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA D-Tree International, Weston, MA, USA Full list of author information is available at the end of the article © 2013 Mitchell et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mitchell et al. BMC Medical Informatics and Decision Making 2013, 13:95 http://www.biomedcentral. com/1472-6947/13/95