Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jul 10;10(7):e0127674.
doi: 10.1371/journal.pone.0127674. eCollection 2015.

Managing the Sick Child in the Era of Declining Malaria Transmission: Development of ALMANACH, an Electronic Algorithm for Appropriate Use of Antimicrobials

Clotilde Rambaud-Althaus  1 , Amani Flexson Shao  2 , Judith Kahama-Maro  3 , Blaise Genton  4 , Valérie d'Acremont  5
Affiliations

Managing the Sick Child in the Era of Declining Malaria Transmission: Development of ALMANACH, an Electronic Algorithm for Appropriate Use of Antimicrobials

Clotilde Rambaud-Althaus et al. PLoS One. .

Abstract

Objective: To review the available knowledge on epidemiology and diagnoses of acute infections in children aged 2 to 59 months in primary care setting and develop an electronic algorithm for the Integrated Management of Childhood Illness to reach optimal clinical outcome and rational use of medicines.

Methods: A structured literature review in Medline, Embase and the Cochrane Database of Systematic Review (CDRS) looked for available estimations of diseases prevalence in outpatients aged 2-59 months, and for available evidence on i) accuracy of clinical predictors, and ii) performance of point-of-care tests for targeted diseases. A new algorithm for the management of childhood illness (ALMANACH) was designed based on evidence retrieved and results of a study on etiologies of fever in Tanzanian children outpatients.

Findings: The major changes in ALMANACH compared to IMCI (2008 version) are the following: i) assessment of 10 danger signs, ii) classification of non-severe children into febrile and non-febrile illness, the latter receiving no antibiotics, iii) classification of pneumonia based on a respiratory rate threshold of 50 assessed twice for febrile children 12-59 months; iv) malaria rapid diagnostic test performed for all febrile children. In the absence of identified source of fever at the end of the assessment, v) urine dipstick performed for febrile children <2 years to consider urinary tract infection, vi) classification of 'possible typhoid' for febrile children >2 years with abdominal tenderness; and lastly vii) classification of 'likely viral infection' in case of negative results.

Conclusion: This smartphone-run algorithm based on new evidence and two point-of-care tests should improve the quality of care of <5 year children and lead to more rational use of antimicrobials.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagrams of study selection process in the structured literature reviews.
Fig 2
Fig 2. Overview of ALMANACH's structure.
mRDT: malaria rapid diagnostic test. UTI: urinary tract infection.
Fig 3
Fig 3. Samples of ALMANACH in paper format.
Fig 4
Fig 4. Samples of ALMANACH in electronic format.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379: 2151–2161. 10.1016/S0140-6736(12)60560-1 - DOI - PubMed
    1. World Health Organization M. Medicines use in primary care in developing and transitional countries [Internet]. World Health Organization (WHO); 2009. Available: http://www.who.int/medicines/publications/who_emp_2009.3/en/
    1. Mayor S. Better access to drugs in developing countries is accelerating resistance. BMJ. 2010;340: c3234 10.1136/bmj.c3234 - DOI - PubMed
    1. Msellem MI, Mårtensson A, Rotllant G, Bhattarai A, Strömberg J, Kahigwa E, et al. Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation study. PLoS Med. 2009;6: e1000070 10.1371/journal.pmed.1000070 - DOI - PMC - PubMed
    1. D’Acremont V, Kahama-Maro J, Swai N, Mtasiwa D, Genton B, Lengeler C. Reduction of anti-malarial consumption after rapid diagnostic tests implementation in Dar es Salaam: a before-after and cluster randomized controlled study. Malar J. 2011;10: 107 10.1186/1475-2875-10-107 - DOI - PMC - PubMed

Publication types