The Added Value of a Mobile Application of Community Case Management on Pediatric Referral Rates in Malawi

The Added Value of a Mobile Application of Community Case Management on Under-5 Referral, Re-consultation and Hospitalization Rates in Malawi: a Pragmatic Stepped-wedge Cluster Randomized Trial

Community Case Management (CCM) is a clinical decision aid used by frontline Health Surveillance Assistants (HSAs) in Malawi to manage uncomplicated cases of pneumonia and malaria (amongst other conditions). Children identified has having complicated illness are urgently referred to larger health facilities better equipped to clinically manage these more complex presentations. There is evidence to suggest HSAs are missing opportunities to refer seriously ill children, and parents/caregivers are failing to comply with urgent referral recommendations when given; reducing the overall effectiveness of the CCM strategy. Use of mobile technology for deploying CCM has been demonstrated in prior research as feasible to evaluate, acceptable to health workers and parents/caregivers and improving health worker fidelity to the guidelines, but it is unknown if this translates into increased referral and referral completion rates. This trial seeks to evaluate the added value of a purpose developed mobile solution for CCM, called Supporting LIFE electronic Community Case Management (SL eCCM App) on HSA referral and parent/caregiver health seeking behavior.

Inclusion Criteria:

• Parents/caregivers aged ≥18 years with spoken fluency in Chichewa, Tonga and Tumbuka
• Children aged ≥2 months to <5 years
• Able/willing to give voluntary verbal consent

Exclusion Criteria:

• Parents/caregivers aged <18 years
• Children aged <2 months or ≥5 years
• Children who are convulsing or unconscious/unresponsive at presentation
• Parents/caregivers unable/unwilling to give voluntary verbal consent