Conference abstract

MSFeCARE: an electronic algorithm to improve antibiotic prescription in the management of childhood illness in primary health care

Pan African Medical Journal - Conference Proceedings. 2018:9(38).21 Dec 2018.
doi: 10.11604/pamj-cp.2018.9.38.765

Contact the corresponding author
Keywords: Pediatric primary health care, mobile health, clinical decision support system, rational antibiotic prescription, quality of care
Oral presentation

MSFeCARE: an electronic algorithm to improve antibiotic prescription in the management of childhood illness in primary health care

Clotilde Rambaud-Althaus1,&, Franck Boninga1, Sergio Cabral1, Nicolas Peyraud1, Maya Shah1, Michel Quere1, Micaela Serafini1, Marie-Claude Bottineau1

1Médecins Sans Frontières (MSF), Geneva, Switzerland

&Corresponding author
Clotilde Rambaud-Althaus, Médecins Sans Frontières (MSF), Geneva, Switzerland


Introduction: MSFeCARE is an electronic clinical decision support system designed to improve quality of care and rational use of antibiotics for childhood illnesses in children < 5 years in primary health care. To assess operational feasibility, acceptability and impact on consultation processes, MSFeCARE was implemented in Berberati, Central African Republic.

Methods: in November, 2016, we implemented MSFeCARE in three MSF-supported rural health centres without Internet access. Following a 1-day training, 24 nurses were asked to conduct paediatric consultations with tablets running MSFeCARE. During monthly visits, we discussed clinical and technical issues and collected MSFeCARE data. We compared rates of antibiotic prescriptions pre and post-intervention as reported in a sample of 200 consultations extracted from registers from January, 2016 and 2017. Coverage of problems encountered and user intent to follow recommendations were assessed through analyses of MSFeCARE data.

Results: MSFeCARE was well accepted by MSF teams, communities, and users. During 2017 first semester, 74% (7496/10164) of under 5 consultations were done using the app. The median duration of consultations was 6 minutes [IQR 4 - 9]. No major technical problems were reported. The nurse heeded the diagnosis and antibiotic prescription advised by MSFeCARE in 97% (7258/7496) and 99% (7467/7496) of consultations respectively. The prescription of antibiotics reported in registers decreased from 47% (93/200) in January, 2016 to 22% (43/200) in January, 2017 (p < 0.001). Users reported the tool was easy to use, helped make precise diagnoses, treatment decisions and allowed to translate training knowledge into practice.

Conclusion: MSFeCARE was reliable, easy to use and well accepted in Berberati. It was correctly used with minimal training. MSFeCARE resulted in a > 50% reduction in antibiotic prescriptions and provided valuable information to guide clinical supervision. The tool holds immense potential to improve the quality of care and reduce irrational antibiotic prescription. Plans are underway for further implementation and continued monitoring.