| Hopkins et al., 2017 [150] |
To research the impact of using rapid diagnostic tests for malaria on subsequent prescriptions of antibiotics in children with acute febrile illnesses in Africa and Asia including Tanzania 522,480 children and adults were enrolled—8 cluster/individually randomized trials and one observational study
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Antibiotics were prescribed to 127,052/238,797 (53%) patients in the control groups and 167,714/283 683 (59%) patients in the intervention groups Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result In most settings, patients with negative test results had more prescriptions for antibiotics than those with positive results for all commonly used classes, e.g., penicillins, trimethoprim-sulfamethoxazole, tetracyclines, and metronidazole, i.e., typically ‘Access’ antibiotics
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| Keitel et al., 2017 [152] |
Determined whether e-POCT was non-inferior in terms of clinical outcomes to IMCI (ALMANACH) when managing febrile illness in children under 5 years Compared the proportion of antibiotic prescriptions and severe adverse events (deaths and secondary hospitalizations) between the 2 arms Overall, 3169 patients took part (randomized between the two arms)
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The absolute proportion of clinical failures was 2.3% in the ePOCT (37/1586) vs. 4.1% (65/1583) in the ALMANACH arm—overall, a 43% reduction in the relative risk of clinical failure when using e-POCT Proportion of severe adverse events was 0.6% in the e-POCT arm vs. 1.5% in the ALMANACH arm (RR 0.42, 95% CI 0.20, 0.87, p = 0.02) Proportion of antibiotic prescriptions was substantially lower with ePOCT—−11.5% compared to 29.7% (RR 0.39, 95% (CI 0.33, 0.45, p < 0.001) With e-POCT, the most common indication for antibiotics was severe disease—this was non-severe respiratory infections with the control algorithm (ALMANACH) The authors concluded that e-POCT has the potential to improve the clinical outcomes of children with febrile illnesses whilst reducing antibiotic use
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| Rambaud-Althaus et al., 2017 [151] |
To assess whether smartphones with guidelines vs. paper support enhances the rational use of medicines among children Pilot cluster-randomized controlled study in Tanzania among 9 primary healthcare facilities—allocated to smartphones, paper-based algorithm, and controls Key outcome measures included proportion of children checked for danger signs to antibiotic prescribing rates
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504 consultations—−166, 171, and 167 in the control, paper, and phone arms, respectively Smartphones vs. paper algorithms resulted in a significant increase in children checked for danger signs—−41% versus 74% (p = 0.04). Antibiotic prescriptions dropped from 70% in the control to 26% and 25%, respectively, in the paper and electronic arms Overall, mobile technology in low-income countries appears implementable and can improve performance Additional POCTs may be needed to enhance appropriate management
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| Keitel et al., 2019 [92] |
Research the safety and efficacy of using C-reactive protein (CRP) to decide on antibiotics among febrile children at risk of pneumonia Controlled non-inferiority at 9 healthcare centers Primary outcome was clinical failure by day 7; secondary outcomes were antibiotic prescription (day 0) and secondary hospitalization or death by day 30
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1726 children were included (intervention: 868, control: 858; 0.7% lost to follow-up) 2.9% (25/865) had clinical failure in the intervention arm at day 7 vs. 4.8% (41/854) in the control arm (risk difference, −1.9%) 2.3% of children in the intervention arm vs. 345 (40.4%) in the control arm received antibiotics (RR, 0.06 [95% CI, 0.04–0.09] Fewer secondary hospitalizations/deaths in the intervention arm: 0.5% vs. 1.5% (RR, 0.30 [95% CI, 0.10–0.93])
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| Olaoye et al., 2020 [42] |
Highlighted the development and implementation of an app to support prudent antimicrobial prescriptions and improved AMS in healthcare facilities in Ghana, Tanzania, Uganda, and Zambia Ascertained from HCPs’ and patients’ attitudes the use of a smartphone to review guidelines before prescribing antibiotics
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The most visited section of the app were the National Prescribing Guidelines—accounting for 66.1% of the total number of hits On a daily basis, mobile phones (28.9%) and printed posters (13.2%) were the most frequently used sources for information on antibiotics among HCPs, with the CwPAMS App mostly used by nurses and other health workers More than 50% of patients had a positive attitude to the use of smartphone apps by HCPs and that this increases the quality of healthcare offered as well as quickens access to healthcare Patients’ greatest concern was that the use of mobile apps may distract from healthcare provision
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| Hogendoorn et al., 2022 [91] |
Tested whether an algorithm using clinical signs and host biomarkers can predict bacterial community-acquired pneumonia vs. viral/unknown pneumonia among patients with LRTIs in outpatient clinics, thereby reducing the prescription of antibiotics A classification and regression tree analysis (CRT) was performed 110 patients with LRTIs and no exclusion criteria from 4 clinics were included
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A CRT analysis was performed with the algorithm forcing the respiratory rate to be the first splitting variable in order to reduce unnecessary laboratory analyses The proposed model had a specificity of 88% and a sensitivity of 88% Using this algorithm restricted the number of patients being prescribed antibiotics to 33/110 (30%) instead of the 55/110 (50%), i.e., a decrease of 40%
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| King et al., 2021 [156] |
Using a standards-based approach adapted to low-resource setting (SafeCare) involving assessments, mentoring, and training to improve the quality of care and to subsequently assess its impact in faith-based and private for-profit facilities Outcome measures included HCW compliance with IPC practices and proportion of SPs who were managed in accordance with STGs 29,608 IPC indications in 5425 provider–patient interactions were observed
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Intervention facilities had 4·4% (95% CI 0·9–7·7; p = 0.015) higher mean SafeCare standards assessment score at the end vs. control facilities but no evidence of differences in clinical quality between intervention and control groups at endline Compliance with IPC practices occurred in 56·9% of intervention facilities vs. 54·7% in control facilities (p = 0.071) Correct management occurred in 27·0% of SPs in the intervention group vs. 29·2% in the control group The lack of any effect on clinical quality could reflect the insufficient intervention intensity and links between structural quality and care processes as well as scarcity of resources for quality improvement
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| Ogunnigbo et al., 2022 [142] |
Ascertained the potential use of a developed app to guide antimicrobial prescriptions/to serve as an educational tool for healthcare students in Africa including Tanzania Structured questionnaire among healthcare students including those from Tanzania
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55.9% of students believed that an application that provides essential information about antimicrobials would be helpful for their learning 52.1% believed a medical information app offline and on the go will help make more informed decisions about antibiotic use
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