Digitizing Clinical Guidelines for the Management of Childhood Illness in Primary Care in Low and Middle-Income Countries (LMICs)

Poor quality of care is estimated to result in 5 million excess deaths per year in low- and middle-income countries (LMICs). The World Health Organization (WHO) has drawn particular attention to the need to improve quality of care for children as part of the strategy to reduce under-five mortality. As part of the Integrated Management of Childhood Illness (IMCI) strategy, simple, structured clinical guidelines have been provided to support health workers to implement evidence-based care. IMCI has been rolled out to over 100 countries and may reduce child mortality by 15% when fully implemented. Yet adherence to the clinical guidelines by frontline health workers, faced with the difficult task of providing care with limited training and resources, remains low in many countries.

Digital technologies provide new opportunities to strengthen quality of care and have recently been recommended by WHO as interventions for health systems strengthening. Clinical decision support systems (CDSS) are digital tools that provide tailored step-by-step guidance through a consultation, aiming at decreasing mis-interpretation of the narrative guidelines by the endpoint users, and have been shown to improve health worker performance including adherence to guidelines

Four humanitarian and research organisations have developed child-health focussed CDSS in low and middle-income countries (LMICs), with evidence to indicate that their implementation can improve health worker performance including adherence to the Integrated Management of Childhood Illness (IMCI) guidelines. The creation of these digital tools – taking into account contextualised users’ experience – led to modifications of the clinical pathway content and generated critical learning for further efforts to promote and harmonise the digitisation of clinical guidelines.