ePOCT+ Rwanda: A Clinical Decision Support Algorithm For Managing Sick Children Below 15 Years of Age in Primary...

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.