The Added Value of a Mobile Application of Community Case Management on Pediatric Referral Rates in Malawi

University of Washington6,995 enrolled

Overview

Community Case Management (CCM) is a clinical decision aid used by frontline Health Surveillance Assistants (HSAs) in Malawi to manage uncomplicated cases of pneumonia and malaria (amongst other conditions). Children identified has having complicated illness are urgently referred to larger health facilities better equipped to clinically manage these more complex presentations. There is evidence to suggest HSAs are missing opportunities to refer seriously ill children, and parents/caregivers are failing to comply with urgent referral recommendations when given; reducing the overall effectiveness of the CCM strategy. Use of mobile technology for deploying CCM has been demonstrated in prior research as feasible to evaluate, acceptable to health workers and parents/caregivers and improving health worker fidelity to the guidelines, but it is unknown if this translates into increased referral and referral completion rates. This trial seeks to evaluate the added value of a purpose developed mobile solution for CCM, called Supporting LIFE electronic Community Case Management (SL eCCM App) on HSA referral and parent/caregiver health seeking behavior.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

6,995

Conditions

Infectious Diseases

Interventions

Supporting LIFE electronic Community Case ManagementOTHER

The SL eCCM App is smartphone application developed to run on Android operating systems 3.0 Honeycomb and above. The SL eCCM App represents an electronic format of the WHO and UNICEFs paper-based CCM clinical decision rule, currently adopted as national policy in Malawi for assessing children presenting to village clinics with acute illness.The App includes a tap-sensitive breath counter for measuring breathing rate.

Eligibility

Sex: ALLMin age: 2 MonthsMax age: 59 Months

Medical Language ↔ Plain English

Inclusion Criteria: * Parents/caregivers aged ≥18 years with spoken fluency in Chichewa, Tonga and Tumbuka * Children aged ≥2 months to \<5 years * Able/willing to give voluntary verbal consent Exclusion Criteria: * Parents/caregivers aged \<18 years * Children aged \<2 months or ≥5 years * Children who are convulsing or unconscious/unresponsive at presentation * Parents/caregivers unable/unwilling to give voluntary verbal consent

Outcomes

Primary Outcomes

Health worker initiated referral of children to higher-level health facilities

Time frame: at the index visit (study enrollment)

Attendance/non-attendance of parent/caregivers given urgent referral recommendation at higher-level health facilities

Time frame: 7-days post-enrollment

Secondary Outcomes

Barriers and facilitators to parent/caregiver compliance with referral recommendations

Time frame: <2-weeks post-enrollment

Acceptability of the SL eCCM App to HSAs and parents/caregivers

Time frame: <2-weeks post-enrollment

Household-level costs associated with healthcare seeking behavior

Time frame: < 2-weeks post-enrollment