Realistic Evaluation of the Integrated Electronic Diagnosis Approach (IeDA) for the Management of Childhood Illnesses at Primary Health Facilities in Burkina Faso.

BACKGROUND: In 2014, Terre des Hommes (Tdh) together with the Ministry of Health (MoH) launched the Integrated electronic Diagnosis Approach (IeDA) intervention in two regions of Burkina Faso consisting of supplying every health centre with a digital algorithm. A realistic evaluation was conducted to understand the implementation process, the mechanisms by which the IeDA intervention lead to change. METHODS: Data collection took place between January 2016 and October 2017. Direct observation in health centres were conducted. In-depth interviews were conducted with 154 individuals including 92 healthcare workers (HCW) from health centres, 16 officers from district health authorities, 6 members of health centre management committees. In addition, 5 focus groups were organised with carers. The initial coding was based on a preliminary list of codes inspired by the middle-range theory (MRT). RESULTS: Our results showed that the adoption of the electronic protocol depended on a multiplicity of management practices including role distribution, team work, problem solving approach, task monitoring, training, supervision, support and recognition. Such changes lead to reorganising the health team and redistributing roles before and during consultation, and positive atmosphere that included recognition of each team member, organisational commitment and sense of belonging. Conditions for such management changes to be effective included open dialog at all levels of the system, a minimum of resources to cover the support services and supervision and regular discussions focusing on solving problems faced by health centre teams. CONCLUSION: This project reinforces the point that in a successful diffusion of IeDA, it is necessary to combine the introduction of technology with support and management mechanisms. It also important to highlight that managers' attitude plays a great place in the success of the intervention: open dialog and respect are crucial dimensions. This is aligned with the findings from other studies.

The African Network for Improved Diagnostics, Epidemiology and Management of common infectious Agents.

BACKGROUND: In sub-Saharan Africa, acute respiratory infections (ARI), acute gastrointestinal infections (GI) and acute febrile disease of unknown cause (AFDUC) have a large disease burden, especially among children, while respective aetiologies often remain unresolved. The need for robust infectious disease surveillance to detect emerging pathogens along with common human pathogens has been highlighted by the ongoing novel coronavirus disease 2019 (COVID-19) pandemic. The African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA) is a sentinel surveillance study on the aetiology and clinical characteristics of ARI, GI and AFDUC in sub-Saharan Africa. METHODS: ANDEMIA includes 12 urban and rural health care facilities in four African countries (Côte d'Ivoire, Burkina Faso, Democratic Republic of the Congo and Republic of South Africa). It was piloted in 2018 in Côte d'Ivoire and the initial phase will run from 2019 to 2021. Case definitions for ARI, GI and AFDUC were established, as well as syndrome-specific sampling algorithms including the collection of blood, naso- and oropharyngeal swabs and stool. Samples are tested using comprehensive diagnostic protocols, ranging from classic bacteriology and antimicrobial resistance screening to multiplex real-time polymerase chain reaction (PCR) systems and High Throughput Sequencing. In March 2020, PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and analysis of full genomic information was included in the study. Standardised questionnaires collect relevant clinical, demographic, socio-economic and behavioural data for epidemiologic analyses. Controls are enrolled over a 12-month period for a nested case-control study. Data will be assessed descriptively and aetiologies will be evaluated using a latent class analysis among cases. Among cases and controls, an integrated analytic approach using logistic regression and Bayesian estimation will be employed to improve the assessment of aetiology and associated risk factors. DISCUSSION: ANDEMIA aims to expand our understanding of ARI, GI and AFDUC aetiologies in sub-Saharan Africa using a comprehensive laboratory diagnostics strategy. It will foster early detection of emerging threats and continued monitoring of important common pathogens. The network collaboration will be strengthened and site diagnostic capacities will be reinforced to improve quality management and patient care.