Almanach: a new electronic algorithm to promote evidence-based medicine and rational use of drugs in primary care for Tanzanian children aged 2 to 59 months : from development to pilot implementation

The rapid spread of antimicrobial resistance is a global public health threat fastened by the overuse of these drugs. Essential to control resistance, rational use of antimicrobial is a challenge in low income countries, where mortality due to infectious diseases is high and diagnostic tools to identify causes of fever are scarce.
To improve primary care management of acute illnesses for children under 5 years, WHO and UNICEF developed in the 1990’s the Integrated Management of Childhood Illness (IMCI). Implemented in more than 75 countries, IMCI has had a limited impact on health workers’ performance and overuse of antimicrobials. The main reasons for this limited impact are the insufficient compliance to recommendations, the insufficient specificity of diagnostic classifications, and the lack of guidance for the management of fever once malaria has been ruled-out.
To address this public health concern, we developed and tested an innovative approach for a safe rational use of antimicrobials in primary care for Tanzanian children. The project had three major components:
(1) Developing a new evidence-based clinical algorithm for childhood illness and its electronic version on mobile devices.
(2) Assessing the safety of the algorithm as compared to routine practice in term of health outcome and antimicrobial prescription.
(3) Assessing the impact of the implementation of the new electronic algorithm on health workers’ performance.