Table 2.

Challenges and potential solutions for the development and implementation of a clinical decision support system in the West African context.

Level	Challenges to CDSSa development	Challenges to CDSS implementation	Potential solutions
Country level	Scarce epidemiological data on the prevalence and incidence of infectious diseases and the level of antimicrobial resistance	N/Ab	Encouraging studies to better analyze the local and regional epidemiology Developing and updating the CDSS according to local and regional epidemiology regarding infectious diseases, microbiology, and antimicrobial resistance Including tuberculosis and common parasitic diseases
	Lack of national guidelines	N/A	The CDSS should follow local, regional, and national guidelines where they exist. If they do not, the CDSS could follow French or WHOc guidelines as they are used by most participants The CDSS should be developed for the subcontinent of West Africa and then could be further adapted to each country To easily adapt the CDSS to local and national guidelines, the programming and code of the CDSS should be in open access
	Limited availability of diagnostic tests and antibiotics	N/A	Adapting the suggestions to locally available diagnostic tests and antibiotics by working with national scientific societies
Health care structure level	N/A	Lack of internet access and information technology infrastructure	Development of an offline mode of the CDSS Development of a mobile version on iOS and Android Increasing the availability of computers and internet access in West Africa
	N/A	Independently operating and geographically isolated health structures such as dispensaries	Pilot testing of the CDSS in a primary care structure linked to an academic hospital before disseminating the tool to other health structures Field communication with primary care prescribers Using the network of the Ministry of Health
Individual level: clinicians and patients	Diversity of training needs for primary care prescribers	N/A	Co-designing the CDSS with general practitioners, nurses, midwives, microbiologists, dentists, and pharmacists Allowing for different modules of access for health professionals to meet the different information needs
	N/A	Lack of awareness and training about CDSS	Dedicated training for primary care prescribers Communicating through scientific and professional societies, using traditional and social media Involving all the stakeholders, including health authorities, the Ministry of Health, and the media
	N/A	Risk of increasing self-treatment with antibiotics as they are available without prescription in most West African countries	Limiting access to registered health professionals (disagreement between participants) Regulating access to antibiotics without prescription
	N/A	Risk of deskilling and dependency of prescribers	Improving the training of prescribers about antibiotic prescribing
	N/A	Risk to lose patients’ confidence by following the advice of an electronic tool	Education of patients about the need to use reference books or electronic sources to provide the best care Ensuring the independence of the tool from pharmaceutical companies

^aCDSS: clinical decisions support system.

^bN/A: not applicable.

^cWHO: World Health Organization.