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

Efforts to improve the diagnosis and management of childhood illness in primary care are a key component of the strategy to reduce under-five mortality in resource-constrained settings. Digital technologies such as Clinical decision support systems (CDSS) provide opportunities to strengthen quality of care and have recently been recommended by WHO as interventions for health systems strengthening.

Four humanitarian and research organisations have developed such 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. Developing the clinical algorithms that underpin these CDSS however, requires translation of narrative guidelines to decision logic, which often requires a degree of interpretation.

In order to promote transparency and work towards best practices around CDSS developments, the GSPI, in partnership with the Geneva Health Forum, has initiated a working group of practitioners, scientists, and policy actors working on IMCI-related CDSS. Based on a comparative analysis of the development of the clinical algorithms of each of the four CDSS, the working group will generate new learning and knowledge on digitization processes, contribute to the most recent work of the World Health Organization in this field, and provide a platform for discussion on clinical algorithm development with a wider audience.

Background

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 adherenceto 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.

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Aim

The process aims toconduct a comparative assessment of the content and structure of the clinical decision support systems (eCDSS)digitized by various organisationsand generate best practices that can benefit the diverse community of policy, humanitarian, scientific and private satekholdesr involved in clinical guidelines digitization.

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Impact

The overall impact of the process is toimprove standardisation of approach to algorithm development to enhance the quality and transparence of clinical decision rules proposed to frontline health worker and advance the development of international policies and practices in this field.

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Key activities

• Working group constitution around an agenda collectively adopted
• Round table discussions during working group sessions with written input provided by members between sessions through semi-structured questionnaires and feedback on draft documents
• Comparison between the included CDSS based on participants’ reflections on the CDSS characteristics and processes of development and / or implementation
• Drafting and publication of a white paper
• Public and expert engagement activities around results

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Project updates

• 16 sept 2021: Webinar Digitising clinical guidelines – What have we learned from existing CDSS in the management of childhood illness in low and middle-income countries (LMICs)?  
• Event recording
• Event slides

• Paper published in Global Health: Science & Practice: “Digitalizing Clinical Guidelines: Experiences in the Development of Clinical Decision Support Algorithms for Management of Childhood Illness in Resource-Constrained Settings“, July 2023