Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial
| Autor: | Tammy Tran, Kanika I. Dharmayat, Victoria Hardy, Matthew Thompson, Tsung-Shu Joseph Wu, John O'Donoghue, Bo Andersson, Ciara Heavin, Phillip H. Hwang, Jenny Hsieh, Yvonne O'Connor, Annette L. Fitzpatrick, Nicole Ide, Adamson S Muula, Sven A. Carlsson, Hsin-yi Lee, Nikolaos Mastellos, Griphin Baxter Chirambo |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Malawi Referral pediatrics Health Informatics Logistic regression Odds community case management Health facility Intervention (counseling) Medicine Humans Child Systemvetenskap informationssystem och informatik Referral and Consultation mobile health 11 Medical and Health Sciences Original Paper mobile phone business.industry Odds ratio Digital health 17 Psychology and Cognitive Sciences Child mortality Hospitalization Emergency medicine 08 Information and Computing Sciences Smartphone childhood infection business Case Management Medical Informatics Information Systems |
| Zdroj: | Journal of Medical Internet Research |
| ISSN: | 1438-8871 |
| Popis: | Background Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Objective We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Methods We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ≥2 months to Results A total of 6965 children were recruited—49.11% (3421/6965) in the control phase and 50.88% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95% CI 0.34-0.59; P Conclusions The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies. Trial Registration ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345 |
| Databáze: | OpenAIRE |
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