e-POCT: improving health outcomes of febrile children in Tanzania through innovative point-of-care technologies at the primary care level

Febrile illnesses are the leading cause for pediatric outpatient consultations in low-resource settings. Only a small percentage of children require antibiotic treatment or inpatient care. The key challenge for clinicians is to identify this minority with serious presentations among the large number of children with self-limiting infections. Health workers tend to prescribe antibiotics in the vast majority of cases, “to be on the safe side”, given the lack of adequate diagnostic tools.
To address these challenges electronic clinical decision algorithms, based on the World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines, had been developed by Swiss TPH. However, opportunities for improvement remain, especially related to the identification of children with serious infections. Host biomarkers, that can help identify children with bacterial infections, had not been considered within the IMCI strategy. In addition, point-of-care tests (POCTs) are available that may help detect children with severe presentations where clinical signs lack diagnostic accuracy, e.g. hemoglobin testing for identifying children with severe anemia. The aim of this project was to improve the clinical outcome and rational antimicrobial prescription among children with acute febrile illnesses through the development and evaluation of a novel electronic disease management tool (ePOCT). The project had two major components: i) development of a novel, evidence-based electronic algorithm, ePOCT, that integrates clinical signs with point-of-care biomarkers, and ii) evaluation of ePOCT through a controlled, randomized, non-inferiority trial in Tanzania.