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@article{Chirambo:2021:10.2196/25777,
author = {Chirambo, GB and Thompson, M and Hardy, V and Ide, N and Hwang, PH and Dharmayat, KI and Mastellos, N and Heavin, C and O, Connor Y and Muula, AS and Andersson, B and O, Donoghue JM and Carlsson, S and Tran, T and Hsieh, JC-L and Lee, H-Y and Fitzpatrick, A and Wu, JTS},
doi = {10.2196/25777},
journal = {Journal of Medical Internet Research},
pages = {1--11},
title = {Effectiveness of smartphone-based community case management on the urgent referral, reconsultation, and hospitalization of children aged under 5 years in Malawi: cluster-randomized, stepped-wedge trial},
url = {http://dx.doi.org/10.2196/25777},
volume = {23},
year = {2021}
}

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TY  - JOUR
AB  - Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi from illnesses such as malaria, pneumonia and diarrhoea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an electronic version of a smartphone-based CCM (eCCM) application on referral, re-consultation and hospitalization rates of children presenting to village clinics in Malawi. Methods: A stepped-wedge cluster-randomized trial compared paper-based CCM (control) with and without use of an eCCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from two districts in Northern Malawi were assigned to one of six clusters which were randomized to the sequencing of crossover from the control to the intervention phases, as well as the duration of exposure in each phase. Children ≥2 months to <5 years presenting with acute illness were enrolled consecutively by Health Surveillance Assistants (HSAs). The primary outcome of urgent referrals to higher-level facilities was evaluated using multi-level mixed effects models. A logistic regression model with random effect of cluster and fixed effect for each step was fitted.  Adjustment for potential confounders included baseline factors, such as patient’s age, sex, and geographical location of village clinics.  Calendar time was adjusted for in the analysis.  Results: A total of 6965 children were recruited, 3421 in the control and 3544 in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility compared with children in the control phase (OR 2.02, 95% CI 1.27-3.23; p<0.01).  Overall, children in the intervention arm had lower odds of attending a repeat HSA consultation (OR 0.45, 95% CI 0.34-0.59; p<0.01) or hospital admission (OR 0.75, 95% CI 0.62-0.90; p<
AU  - Chirambo,GB
AU  - Thompson,M
AU  - Hardy,V
AU  - Ide,N
AU  - Hwang,PH
AU  - Dharmayat,KI
AU  - Mastellos,N
AU  - Heavin,C
AU  - O,Connor Y
AU  - Muula,AS
AU  - Andersson,B
AU  - O,Donoghue JM
AU  - Carlsson,S
AU  - Tran,T
AU  - Hsieh,JC-L
AU  - Lee,H-Y
AU  - Fitzpatrick,A
AU  - Wu,JTS
DO  - 10.2196/25777
EP  - 11
PY  - 2021///
SN  - 1438-8871
SP  - 1
TI  - Effectiveness of smartphone-based community case management on the urgent referral, reconsultation, and hospitalization of children aged under 5 years in Malawi: cluster-randomized, stepped-wedge trial
T2  - Journal of Medical Internet Research
UR  - http://dx.doi.org/10.2196/25777
UR  - https://www.jmir.org/2021/10/e25777
UR  - http://hdl.handle.net/10044/1/91072
VL  - 23
ER  -

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