Infectious Diseases
Conditions
Brief summary
Community Case Management (CCM) is a clinical decision aid used by frontline Health Surveillance Assistants (HSAs) in Malawi to manage uncomplicated cases of pneumonia and malaria (amongst other conditions). Children identified has having complicated illness are urgently referred to larger health facilities better equipped to clinically manage these more complex presentations. There is evidence to suggest HSAs are missing opportunities to refer seriously ill children, and parents/caregivers are failing to comply with urgent referral recommendations when given; reducing the overall effectiveness of the CCM strategy. Use of mobile technology for deploying CCM has been demonstrated in prior research as feasible to evaluate, acceptable to health workers and parents/caregivers and improving health worker fidelity to the guidelines, but it is unknown if this translates into increased referral and referral completion rates. This trial seeks to evaluate the added value of a purpose developed mobile solution for CCM, called Supporting LIFE electronic Community Case Management (SL eCCM App) on HSA referral and parent/caregiver health seeking behavior.
Interventions
OTHERSupporting LIFE electronic Community Case Management
The SL eCCM App is smartphone application developed to run on Android operating systems 3.0 Honeycomb and above. The SL eCCM App represents an electronic format of the WHO and UNICEFs paper-based CCM clinical decision rule, currently adopted as national policy in Malawi for assessing children presenting to village clinics with acute illness.The App includes a tap-sensitive breath counter for measuring breathing rate.
OTHERStandard care
Sponsors
Imperial College London
University College Cork
Lund University
Mzuzu University
Luke International Norway
University of Washington
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
2 Months to 59 Months
Healthy volunteers
No
Inclusion criteria
* Parents/caregivers aged ≥18 years with spoken fluency in Chichewa, Tonga and Tumbuka * Children aged ≥2 months to \<5 years * Able/willing to give voluntary verbal consent
Exclusion criteria
* Parents/caregivers aged \<18 years * Children aged \<2 months or ≥5 years * Children who are convulsing or unconscious/unresponsive at presentation * Parents/caregivers unable/unwilling to give voluntary verbal consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Health worker initiated referral of children to higher-level health facilities | at the index visit (study enrollment) |
| Attendance/non-attendance of parent/caregivers given urgent referral recommendation at higher-level health facilities | 7-days post-enrollment |
Secondary
| Measure | Time frame |
|---|---|
| Barriers and facilitators to parent/caregiver compliance with referral recommendations | <2-weeks post-enrollment |
| Acceptability of the SL eCCM App to HSAs and parents/caregivers | <2-weeks post-enrollment |
| Household-level costs associated with healthcare seeking behavior | < 2-weeks post-enrollment |
Outcome results
None listed