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Malaria in Tanzania
During the past 20 years since the first IMCI protocols were developed, patterns of disease and drug resistance has changed dramatically and the protocols have often not kept pace with these changes. As an example, the prevalence of malaria among febrile children in Dar es Salaam has gone down dramatically during this period due to improvements in sanitation and housing and the wider use of insecticide treated bed nets. Further during this period, the drug of choice for treatment has gone from chloroquine which was inexpensive and relatively safe to ALU and quinine which are relatively expensive and have many side effects. While the treatment recommendations in IMCI have changed, despite the evidence that only 10% of children with fever in Dar es Salaam have malaria all these children are treated for malaria at great expense and risk.
Our work in malaria takes advantage of the recent development of a Rapid Diagnostic Test (RDT) for Malaria which has made it possible to accurately diagnosis malaria in rural outpatient clinics in Tanzania. Building on this technology, D-tree together with the Swiss Tropical Institute are testing an innovative approach to the diagnosis and treatment of children with fever in Tanzania using hand held electronic decision support incorporating the use of RDTs for children that have fever. Through a pilot project, we expect to show that it is feasible and necessary to:
- Revise standardized diagnostic and treatment procedures for the management of childhood illness (IMCI) incorporating more sophisticated clinical algorithms based on current evidence about disease patterns and drug resistance;
- Rapidly incorporate these changes into treatment algorithms in an electronic format that is accurately used; and
- Demonstrate improved clinical and cost effectiveness of electronic algorithms when compared to the used of paper based IMCI algorithms leading to a reduction in the inappropriate use of antibiotics and antimalarials for children with fever.
This project addresses two key factors critical for the improvement of quality of health care in developing countries: (1) the need to continually revise and update evidence based clinical medicine as new evidence and technologies become available, and (2) the need to increase use of these revised standards in a timely and cost effective way.
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