Results from one-year use of an electronic Clinical Decision Support System in a post-conflict context: An implementation research

Autoři: Andrea Bernasconi aff001;  Francois Crabbé aff002;  Ajibola Margret Adedeji aff004;  Attahiru Bello aff005;  Torsten Schmitz aff002;  Marco Landi aff004;  Rodolfo Rossi aff006
Působiště autorů: ICRC, Kyaing Tong, Myanmar aff001;  HTTU, Swiss TPH, Basel, Switzerland aff002;  University of Basel, Basel, Switzerland aff003;  ICRC, Yola, Nigeria aff004;  Adamawa State Primary Healthcare Development Agency, Adamawa, Nigeria aff005;  PHC programs, ICRC, Genève, Switzerland aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225634



In 2017, the Adamawa State Primary Healthcare Development Agency introduced ALMANACH, an electronic clinical decision support system based on a modified version of IMCI. The target area was the Federal State of Adamawa (Nigeria), a region recovering after the Boko Haram insurgency. The aim of this implementation research was to assess the improvement in terms of quality care offered after one year of utilization of the tool.


We carried out two cross-sectional studies in six Primary Health Care Centres to assess the improvements in comparison with the baseline carried out before the implementation. One survey was carried out inside the consultation room and was based on the direct observation of 235 consultations of children aged from 2 to 59 months old. The second survey questioned 189 caregivers outside the health facility for their opinion about the consultation carried out through using the tablet, the prescriptions and medications given.


In comparison with the baseline, more children were checked for danger signs (60.0% vs. 37.1% at baseline) and in addition, children were actually weighed (61.1% vs. 27.7%) during consultation. Malnutrition screening was performed in 35.1% of children (vs. 12.1%). Through ALMANACH, also performance of preventive measures was significantly improved (p<0.01): vaccination status was checked in 39.8% of cases (vs. 10.6% at baseline), and deworming and vitamin A prescription was increased to 46.5% (vs. 0.7%) and 48.3% (vs. 2.8%) respectively. Furthermore, children received a complete physical examination (58.3% vs. 45.5%, p<0.01) and correct treatment (48.4% vs. 29.5%, p<0.01). Regarding antibiotic prescription, 69.3% patients received at least one antibiotic (baseline 77.7%, p<0.05).


Our findings highlight major improvements in terms of quality of care despite many questions still pending to be answered in relation to a full integration of the tool in the Adamawa health system.

Klíčová slova:

Antibiotics – Clinical decision support systems – Fevers – Malaria – Quality of care – Social systems – Vaccination and immunization – Vitamin A


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2019 Číslo 12