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Published on: April 9, 2012
Using a mobile application to improve pediatric presumptive TB identification in western Kenya
D Szkwarko1, J A Amisi2, D Peterson3
1Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA.
Insights
A mobile app led by community health volunteers significantly improved the identification of presumptive tuberculosis (TB) in children in Kenya. This intervention proved feasible, appropriate, and effective for healthcare workers.
Area of Science:
- Public Health
- Pediatrics
- Digital Health
Background:
- Early recognition of pediatric tuberculosis (TB) is crucial for timely diagnosis and treatment.
- Healthcare workers in high TB burden settings face challenges with presumptive TB screening due to competing priorities.
- A mobile application intervention was evaluated for feasibility, appropriateness, and effectiveness in pediatric primary care.
Purpose of the Study:
- To assess the feasibility, appropriateness, and effectiveness of a community health volunteer-led mobile application for presumptive pediatric TB screening.
- To improve the identification and notification of presumptive TB cases in children in western Kenya.
Main Methods:
- A mixed-methods participatory and iterative approach was used to design and implement the presumptive pediatric TB mobile android application (PPTBMAPP).
- The intervention was implemented over a 6-month period in pediatric outpatient primary care clinics.
- Proportions of children in presumptive TB and active TB registers were compared before and after implementation.
Main Results:
- Out of 1787 children screened, 376 (21%) met presumptive TB criteria.
- A statistically significant increase in the proportion of children in presumptive TB registers was observed (10.7% vs. 16.2%, P = 0.0005).
- Healthcare workers reported the application expedited the presumptive TB screening process.
Conclusions:
- The community health volunteer-led mobile screening intervention significantly increased presumptive TB notification rates.
- Healthcare workers found the mobile screening intervention to be feasible, appropriate, and effective.
- Mobile health interventions show promise for enhancing pediatric TB screening in resource-limited settings.
Abstract:
BACKGROUND: Early recognition of TB symptoms in children is critical in order to link children to appropriate testing and treatment. Healthcare workers (HCWs) in high TB burden countries are often overburdened with competing clinical priorities, leading to incomplete presumptive TB screening. We assessed if implementing a community health volunteer (CHV) led presumptive pediatric TB mobile android application (PPTBMAPP) in pediatric outpatient, primary care clinics in western Kenya would be feasible, appropriate, and effective.METHODS: We used a mixed-methods participatory, iterative approach to design and implement the PPTBMAPP during a 6-month period. We compared the proportion of children identified in presumptive TB and active TB disease registers out of all patients before and after the implementation of the intervention.RESULTS: Of the 1787 children aged ≤15 years screened using the PPTBMAPP, 376 (21%) met the criteria for presumptive TB. There was a statistically significant increase in the proportion of children to all patients in the presumptive TB registers (97/908, 10.7% vs. 160/989, 16.2%; P = 0.0005), and a trend towards an increase in the proportion of children to all patients in the TB case register (17/117, 14.5% vs. 15/83, 18.1%; P = 0.5). HCWs interviewed commented that the application sped up the presumptive TB screening process.CONCLUSION: Our CHV-led mobile screening intervention significantly increased presumptive TB notification. HCWs reported that the mobile screening intervention was feasible, appropriate, and effective.
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