In a groundbreaking collaboration, scientists at Ifakara Health Institute, National Institute of Medical Research – Mbeya Medical Research Centre (NIMR-MMRC), Unisanté, and the Swiss Tropical and Public Health Institute (Swiss TPH) have successfully developed a digital algorithm-based tool that significantly reduces antibiotic prescriptions in children.

The tool's effectiveness was tested in a large cluster randomized trial involving 20 health facilities in Tanzania. The trial involved over 20,000 consultations across 11 months whereby the digital decision support tool significantly decreased antibiotic prescriptions to children, with no effect on clinical outcomes

Published in December in the esteemed Nature Medicine journal yesterday, the findings of the study titled "A Digital Health Algorithm to Guide Antibiotic Prescription in Pediatric Outpatient Care: A Cluster Randomized Controlled Trial" are part of the broader DYNAMIC project. 

Launched in 2019 by Unisanté's Digital and Global Health Unit, the DYNAMIC project, a 5-year research initiative aims to enhance care quality and reduce antibiotic prescriptions by deploying the ePOCT+ clinical decision support algorithm. The project is currently implemented in over 100 health facilities in Tanzania and Rwanda, with ongoing efforts to further improve the tool's effectiveness.

The antibiotic resistance challenges
Bacterial antimicrobial resistance claimed an estimated 1.27 million lives in 2019, with sub-Saharan Africa bearing the highest burden. Antibiotic overuse is a major contributor to rising resistance rates, prompting the need for innovative solutions to curb unnecessary prescriptions.

Significance of the digital tool
To address the challenge of antibiotic resistance, researchers developed the clinical decision support algorithm for pediatric consultations, utilizing point-of-care tests aligned with WHO and Tanzanian clinical guidelines. After testing the tool’s efficacy, results revealed a substantial decrease in antibiotic prescriptions, from 70.1% in facilities without the tool to 23.2% where it was deployed. 

While acknowledging the need for consistent tool usage, researchers believe the study presents a scalable and cost-effective solution to reduce antibiotic prescriptions safely. 

Dr. Leah Rwezaula, Clinical Officer, Doctor in charge of Iganzo Disensary, and clinician using the digital tool says, “This tool has helped build my capacity. When I am attending to a patient, it helps me treat the patient better.…”

Dr. Lameck Luwanda, a Research Scientist at Ifakara Health Institute and author of the study says, “I believe we are making significant strides in mitigating antimicrobial resistance. The seamless integration of this tool into established platforms like GoTHOMIS, and its subsequent deployment across numerous primary health facilities, holds the potential to significantly enhance our ability to save more lives.”

Read the full publication here.