An electronic clinical support algorithm integrating the Integrated Management of Childhood Illness with malaria and bacterial point-of-care diagnostics to improve outpatient care of febrile children in malaria-endemic settings: e-IMCI+

Background In sub-Saharan Africa, health systems face challenges in reducing the burden of infectious diseases due to the limited availability of qualified human resources in remote areas. Digital clinical decision support implemented to address this issue failed due to the lack of point-of-care (PoC) tests to guide the clinical decision. In this paper, we describe the development of a target product profile (TPP) integrating clinical information and PoC tests, for the management of febrile diseases in children under 5 years. Methods Based on the integrated management of childhood illness (IMCI) guideline, which is implemented in Burkina Faso, a simplified decision tree has been established, digitalized on electronical support for non-clinicians use in our study area, to guide the management of febrile illness. The list of PoC test has been defined based on local epidemiology data. The TPP has been developed by a panel of health professionals involved in the daily management of children under 5 years, and was designed to be compatible with Android. End-users and beneficiaries have been involved as the co-designers at the last stage of the development to guarantee that the final TPP meets their needs. Results Beneficiary and end-users gave positive feedback on the final TPP's design, user-friendliness, and clinical information collection. They appreciated the ease of navigation but noted the lack of possibility to specify the diagnostic for non-bacterial and non-viral infections for e-Algorithm and suggested an open list of final diagnostic. The e-algorithm development panel suggested keeping diagnostic lists limited, but offered the possibility of concomitant treatments information following by justification. They have also positively appreciated the RDT-decisional algorithm for the management of febrile children. Conclusion The algorithm proposed appears to be very promising. However, it is important to ensure that the TPP operates properly in real condition and could improve the management of febrile diseases in children under 5 years.