Evaluating a mobile health tool to guide management of acute respiratory illnesses in young children in Uganda

Introduction: Although acute lower respiratory illnesses (ALRIs) are a leading cause of death in young children, adherence to evidence-based guidelines remains low. We created ALRITE (Acute Lower Respiratory Illness Treatment Evaluation), a point-of-care, Integrated Management of Childhood Illness (IMCI)-based mobile health application to guide ALRI diagnosis/management in Uganda. Methods: Pilot feasibility study following ALRITE deployment in two primary care Ugandan health centers. Outpatient clinicians were eligible for participation. We conducted training on the use of ALRITE and ALRI management at each center and provided ALRITE-enabled tablets to clinicians for 3 months. ALRITE use was not required, and clinicians were encouraged to override the ALRITE diagnosis if they disagreed. We collected ALRITE use data, clinical information, and implementation outcome measures (adoption, acceptability, and feasibility). Results: All eligible clinicians were enrolled. One month after enrollment, 5 clinicians were actively using ALRITE (adoption 63%); by 6 weeks, active users dropped to 2 (28.6%). ALRITE was initiated for 159/1139 pediatric encounters; 4 encounters were incomplete. Primary ALRITE diagnosis included 37(24%) severe pneumonia or very severe disease, 32(21%) pneumonia, 82(53%) cough/cold/no pneumonia, and 6(4%) no signs of respiratory Illness; ALRITE additionally diagnosed 4(3%) with wheezing illness. Diagnostic concordance between ALRITE and clinician was 70%. Forty percent of discordance occurred when clinicians marked a WHO Danger Sign, likely inappropriately, for a child with less severe disease. Facilitators of ALRITE use included clinician/caregiver stories of positive patient outcomes, clinicians’ perception of improved guideline adherence, and ease of use. Barriers included usability, time constraints, knowledge gaps, and inadequate staffing. Conclusions: Use of the ALRITE mobile health tool in Ugandan health centers is feasible. Next steps include addressing discordance and improving user experience and functionality by modifying ALRITE’s content, format, and delivery mode. Results will inform a larger trial evaluating ALRITE’s impact on clinical care in Ugandan health centers.