The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms.

Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal. Devices are implemented with guidance and training, mentorship, and community engagement. Sociodemographic and clinical data are collected from caregivers and records of enrolled sick children aged 0-59 months at study facilities, with phone follow-up on Day 7 (and Day 28 in the RCT). The primary outcomes assessed for the RCT are severe complications (mortality and secondary hospitalisations) by Day 7 and primary hospitalisations (within 24 hours and with referral); and, for the pre-post study, referrals and antibiotic. Secondary outcomes on other aspects of health status, hypoxaemia, referral, follow-up and antimicrobial prescription are also evaluated. In all countries, embedded mixed-method studies further evaluate the effects of the intervention on care and care processes, implementation, cost and cost-effectiveness. Pilot and baseline studies started mid-2021, RCT and post-intervention mid-2022, with anticipated completion mid-2023 and first results late-2023. Study approval has been granted by all relevant institutional review boards, national and WHO ethical review committees. Findings will be shared with communities, healthcare providers, Ministries of Health and other local, national and international stakeholders to facilitate evidence-based decision-making on scale-up.Study registration: NCT04910750 and NCT05065320.

Pulse oximetry and clinical decision support algorithms show potential for supporting healthcare providers to identify and manage severe illness among children under-five attending primary care in resource-constrained settings, whilst promoting resource stewardship but scale-up has been hampered by evidence gaps.This study design article describes the largest scale evaluation of these interventions to date, the results of which will inform country- and global-level policy and planning .

L'impact des modalites d'allocation des ressources dans les mecanismes d'exemption sur l'equite : Plan Sesame; Senegal

La plupart des politiques d'exemption en Afrique subsaharienne se dotent de facto de modalites dites passives d'allocation de ressources. Le Plan Sesame - mecanisme d'exemption adopte au Senegal en 2006 et ciblant les citoyens ages de 60 ans et plus - n'echappe pas a la regle : il se base sur le paiement a l'acte comme modalite d'achat de services. Ce texte a pour but d'explorer l'effet de cette modalite passive d'achat de services sur l'equite d'acces aux soins du Plan Sesame. Notre analyse se base sur une enquete menee au Senegal entre mai 2012 et juillet 2013. Une methodologie mixte incluant une revue de documents de politiques; une analyse des detenteurs d'enjeux et une enquete-menage a ete utilisee. Les resultats montrent que le Plan Sesame est caracterise par un financement hybride; lequel a favorise les personnes agees evoluant dans le secteur formel qui ont un meilleur acces aux hopitaux. Ceux-ci ont donc capte une grande partie des budgets alloues au Plan Sesame. En somme; les couches sociales les plus aisees et celles residant en milieu urbain ont plus de chance d'acceder aux ressources du Plan Sesame