System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Research Support, Non-U.S. Gov't Randomized Controlled Trial Ppublish 4 citations

PubMed: 38683158 DOI: 10.1080/16549716.2024.2326253

The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms.

Glob Health Action 17(1):2326253

Authors: Fenella Beynon, Hélène Langet, Leah F Bohle, Shally Awasthi, Ousmane Ndiaye, James Machoki M'Imunya, Honorati Masanja, Susan Horton, Maymouna Ba, Silvia Cicconi, Mira Emmanuel-Fabula, Papa Moctar Faye, Tracy R Glass, Kristina Keitel, Divas Kumar, Gaurav Kumar, Gillian A Levine, Lena Matata, Grace Mhalu, Andolo Miheso, Deusdedit Mjungu, Francis Njiri, Elisabeth Reus, Michael Ruffo, Fabian Schär, Kovid Sharma, Helen L Storey, Irene Masanja, Kaspar Wyss, Valérie D'Acremont

Affiliations

  • Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
  • Faculty of Science, University of Basel, Basel, Switzerland.
  • Department of Paediatrics, King George's Medical University, Lucknow, India.
  • Faculté de médecine, Université Cheikh Anta Diop, Dakar, Senegal.
  • College of Health Sciences, University of Nairobi, Nairobi, Kenya.
  • Directorate, Ifakara Health Institute, Dar es Salaam, Tanzania.
  • School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
  • PATH.
  • Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
  • Division of Pediatric Emergency Medicine, Department of Pediatrics,Inselspital, University of Bern, Bern, Switzerland.
  • Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania.
  • Digital Global Health Department, Centre for Primary Care and PublicHealth (Unisanté), University of Lausanne, Lausanne, Switzerland.

Abstract

Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal. Devices are implemented with guidance and training, mentorship, and community engagement. Sociodemographic and clinical data are collected from caregivers and records of enrolled sick children aged 0-59 months at study facilities, with phone follow-up on Day 7 (and Day 28 in the RCT). The primary outcomes assessed for the RCT are severe complications (mortality and secondary hospitalisations) by Day 7 and primary hospitalisations (within 24 hours and with referral); and, for the pre-post study, referrals and antibiotic. Secondary outcomes on other aspects of health status, hypoxaemia, referral, follow-up and antimicrobial prescription are also evaluated. In all countries, embedded mixed-method studies further evaluate the effects of the intervention on care and care processes, implementation, cost and cost-effectiveness. Pilot and baseline studies started mid-2021, RCT and post-intervention mid-2022, with anticipated completion mid-2023 and first results late-2023. Study approval has been granted by all relevant institutional review boards, national and WHO ethical review committees. Findings will be shared with communities, healthcare providers, Ministries of Health and other local, national and international stakeholders to facilitate evidence-based decision-making on scale-up.: NCT04910750 and NCT05065320.

MeSH

Global Health, Oximetry, Multiple Chronic Conditions, Algorithms, Health Personnel, Pulse, Child

Cited by