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ePOCT+ Rwanda: A Clinical Decision Support Algorithm For Managing Sick Children Below 15 Years of Age in Primary
Vera von Kalckreuth1,2, Victor P Rwandarwacu1, Ludovico Cobuccio1,3
1Swiss Tropical and Public Health Institute, Kigali, Rwanda.
Insights
Digital clinical decision support algorithms (CDSAs) improve antibiotic prescribing in resource-limited areas. The ePOCT+ Rwanda CDSA, based on WHO guidelines, aids diagnosis and management for children, reducing antimicrobial resistance risks.
Area of Science:
- Digital health interventions
- Global health
- Clinical decision support systems
Background:
- Resource-constrained primary health systems face challenges like staff shortages and diagnostic uncertainty, leading to antibiotic overuse and antimicrobial resistance.
- Digital clinical decision support algorithms (CDSAs) can enhance guideline adherence and improve prescribing practices among healthcare workers.
- The DYNAMIC project aimed to address these issues in Rwanda through innovative digital tools.
Purpose of the Study:
- To present the scope and content of the 'ePOCT+ Rwanda' (electronic Point-Of-Care Tests +) CDSA.
- To describe the adaptation of the algorithm based on WHO IMCI guidelines for Rwandan paediatric primary care.
- To detail the integration of specific point-of-care tests within the CDSA.
Main Methods:
- The ePOCT+ Rwanda CDSA was developed based on WHO IMCI guidelines, expanded for ages 1 day to 14 years.
- The algorithm covers 57 diagnoses for young infants (<2 months) and 144 diagnoses for children (2 months to 14 years).
- A digital application guided users through medical history, physical exams, and lab tests to suggest diagnoses and management, incorporating haemoglobin, C-reactive protein tests, and pulse oximetry.
Main Results:
- The ePOCT+ Rwanda CDSA was successfully trialed in primary health centers in Rusizi and Nyamasheke districts.
- The algorithm integrates clinical data with point-of-care test results to provide diagnostic and treatment recommendations.
- Alignment with Rwandan paediatric guidelines and adaptation for primary care settings were key aspects of its development.
Conclusions:
- The ePOCT+ Rwanda CDSA offers a structured approach to diagnosis and management in primary care settings with limited resources.
- By supporting evidence-based prescribing, the CDSA has the potential to mitigate antimicrobial resistance.
- Further integration of digital tools like ePOCT+ is crucial for strengthening primary healthcare systems in resource-constrained environments.
Abstract:
Primary health systems in resource-constrained settings suffer from human resource shortages, low quality care, and diagnostic uncertainty, resulting in over-reliance on antibiotics, increasing risks of antimicrobial resistance. Digital clinical decision support algorithms (CDSAs) help healthcare workers adhere to clinical guidelines and improve prescribing practices. In this manuscript, we present the scope and content of 'ePOCT+ Rwanda' (electronic Point-Of-Care Tests +), a CDSA trialed in primary health centers of Rusizi and Nyamasheke districts during the DYNAMIC project. The algorithm is based on the WHO IMCI guidelines, expanded to include a broader range of ages (between 1 day and 14 years, inclusive) and acute medical conditions encountered in primary care (57 diagnoses for young infants < 2 months and 144 diagnoses for children 2 months to 14 years). The digital application used to deploy ePOCT+ prompts users to enter the results of medical history, physical examinations and laboratory tests to propose diagnoses, treatments and managements. In addition to routine point-of-care tests, ePOCT+ utilizes haemoglobin and C-reactive protein tests, as well as pulse oximetry, targeted to specific clinical conditions. We discuss the rationale behind the content of the algorithm and the process of aligning it with the Rwandan paediatric guidelines and tailoring it to the primary care setting.
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