1. Digitalised IMCI management algorithms on tablet: Results of the ALMANACH Project in Nigeria and Afghanistan
A. Bernasconi 1,2, F. Crabbé 1,2, A. Vanobberghen 1,2, R. Rossi3, S. Du Mortier3, M. Raab 1,2
1HTTU, Swiss TPH, Basel, Switzerland; 2University of Basel, Switzerland 3 PHC programs, ICRC, Genève, Switzerland
Introduction
Results
Integrated Management of Childhood Illness (IMCI) was developed to reduce child morbidity and mortality, it is now introduced in more than 100 countries and it has been associated with a 15% reduction in child mortality.
ALMANACH has been used for more than one year in 3 health facilities in Afghanistan and in 12 facilities in Nigeria children from 2 months to 5 years old have so far been treated with ALMANACH
AFGHANISTAN
NIGERIA
Methodology
ALMANACH (ALgorithm for the MANagement of Acute CHildhood illnesses) is an electronic and upgraded version of the IMCI available on tablet based on algorithms designed upon:
National version of the IMCI
Specific program protocols (malaria, malnourishment, TB, ..)
National therapeutic guidelines
Evidence based literature
Resources available in terms of staff, drug supply, equipment and laboratory tests
Evidence of possible antibiotic resistance
On the basis of these algorithms, during the consultation, ALMANACH recommends:
which examinations to perform,
when to refer,
when to use a rapid diagnostic test,
what treatment to prescribe and at what dosage,
what preventive services (deworming, vaccination, vitamin A) to provide.
After the consultation ALMANACH synchronizes the data collected with a Health Information System (DHIS2) in real time.
Preventive Measures
Proper Examination
Therapy
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Epidemiologists and health managers have now the information needed to steer their projects and to investigate the trends of the diseases
Conclusion
The ALMANACH tablet has proved to be simple, practical and user-friendly. It has contributed to improving the quality of pediatric care at health facilities managed by staff with limited skills. However, the ALMANACH tool must be supported by an operational primary health care system.
The Nigerian experience also suggests that more has to be done to control the unnecessary prescription of antibiotics.