| Paper | Digital solutions to improve childhood illness management in resource-constrained settings: a comparative analysis

A collaborative effort among practitioners, scientists, and policy actors has produced insights into the development of Clinical Decision Support Systems (CDSSs) aimed at improving the management of childhood illness in resource-constrained settings.

Over the past decade, an increasing number of global health actors such as humanitarian NGOs¹, international organisations², or multistakeholder partnerships³ have launched digital solutions to help health care providers improve the quality of diagnostics and management of childhood illnesses. Based on collaborations with scientific institutions⁴, technical specialists and public health actors, these initiatives have shown great potential for saving lives but remain complex to undertake and deploy.The working group was formed to provide insights on the complex process of translating clinical recommendations into decision logic. Its findings – published recently as a technical note –  provide original knowledge on the methods for developing clinical algorithms considering various dimensions such as context, content and structure.The analysis compares four CDSSs developed for primary care settings in LMICs. The study's authors reveal that overall three types of adaptations were undertaken in the algorithm development process:

1. Extended scope: the CDSSs expanded beyond the scope of the original guidelines provided by the WHO (IMCI) to include a wider range of health conditions.
2. Content enhancement: additional or modified content was integrated into the CDSSs to improve diagnostic accuracy, align with new evidence, and support rational resource utilisation, particularly in the prescription of antimicrobials.
3. Revised structure: the linear approach of the original IMCI guidelines was adapted in CDSSs to streamline consultations, improve usability, and expedite the identification and management of severe illnesses.

The study also highlights the need for clear and transparent documentation of clinical algorithms for validation and stakeholder engagement."We all did a thorough and lengthy effort to adapt the generic clinical protocols to the unique contexts: from users' needs to  workflow. This is of paramount importance to allow the provision of better and faster health services", said Riccardo Lampariello, Chief Executive Officer at D-tree and one of the authors of the publication.This collaborative effort has contributed to ongoing discussions surrounding CDSS quality, transparency, and impact on health care in resource-constrained settings. It also fed the WHO’s SMART Guidelines initiative, aimed at facilitating the digitalisation of WHO recommendations.

‍Importance of multistakeholder collaboration

‍The study underscores the importance of collaboration among diverse stakeholders, including health care providers, researchers, policy actors and caregivers. Multistakeholder engagement ensures that CDSSs are contextually relevant, evidence-based, and well-suited to the needs of the target population.

As childhood illness management evolves with digital solutions, this study provides critical insights into creating effective, contextually relevant, and evidence-based CDSSs. By emphasising collaboration, transparency, and standardised approaches, CDSSs have the potential to significantly improve the quality of care for children in resource-constrained settings, reducing morbidity and mortality rates.

The collaborative process within the eIMCI working group was supported by the GSPI from 2019 to 2022. For more information, access the full text here.^‍

¹Terre des Hommes, Médecins sans Frontières, ICRC^‍

²World Health Organisation^‍

³FIND^‍

⁴University of Geneva, Unisanté, Swiss TPH‍

Image credit: MSF