Abstract
BackgroundIn 2017, the Adamawa State Primary Healthcare Development Agency introduced ALMANACH, an electronic clinical decision support system based on a modified version of IMCI. The target area was the Federal State of Adamawa (Nigeria), a region recovering after the Boko Haram insurgency. The aim of this implementation research was to assess the improvement in terms of quality care offered after one year of utilization of the tool.MethodsWe carried out two cross-sectional studies in six Primary Health Care Centres to assess the improvements in comparison with the baseline carried out before the implementation. One survey was carried out inside the consultation room and was based on the direct observation of 235 consultations of children aged from 2 to 59 months old. The second survey questioned 189 caregivers outside the health facility for their opinion about the consultation carried out through using the tablet, the prescriptions and medications given.ResultsIn comparison with the baseline, more children were checked for danger signs (60.0% vs. 37.1% at baseline) and in addition, children were actually weighed (61.1% vs. 27.7%) during consultation. Malnutrition screening was performed in 35.1% of children (vs. 12.1%). Through ALMANACH, also performance of preventive measures was significantly improved (p<0.01): vaccination status was checked in 39.8% of cases (vs. 10.6% at baseline), and deworming and vitamin A prescription was increased to 46.5% (vs. 0.7%) and 48.3% (vs. 2.8%) respectively. Furthermore, children received a complete physical examination (58.3% vs. 45.5%, p<0.01) and correct treatment (48.4% vs. 29.5%, p<0.01). Regarding antibiotic prescription, 69.3% patients received at least one antibiotic (baseline 77.7%, p<0.05).ConclusionsOur findings highlight major improvements in terms of quality of care despite many questions still pending to be answered in relation to a full integration of the tool in the Adamawa health system.
Highlights
In the 1990s the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) elaborated the Integrated Management of Childhood Illness (IMCI) strategy
In 2017, the Adamawa State Primary Healthcare Development Agency introduced ALMANACH, an electronic clinical decision support system based on a modified version of IMCI
Through ALMANACH, performance of preventive measures was significantly improved (p
Summary
In the 1990s the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) elaborated the Integrated Management of Childhood Illness (IMCI) strategy. The benefits of the strategy are well known and understood, in the last decades the implementation in several countries was hampered Reasons for this were weak leadership, competition of various vertical programs, missing of a tailored tool to the epidemiological profile of the targeted population, and to the resources (staff skill level, drugs, equipment and laboratory procedures) available at PHC and a long and expensive training of the end-users [5,6,7,8]. The target area was the Federal State of Adamawa (Nigeria), a region recovering after the Boko Haram insurgency The aim of this implementation research was to assess the improvement in terms of quality care offered after one year of utilization of the tool
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