Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Sep 20, 2024)
Date Submitted: Nov 3, 2023
Open Peer Review Period: Nov 3, 2023 - Dec 29, 2023
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Assessing the Accuracy of an Electronic Platform for Childhood Illnesses Management in Rual China: A Cluster Randomized Controlled Trial
ABSTRACT
Background:
The Integrated Management of Childhood Illness (IMCI) faces challenges like high training costs and limited literacy among community health workers (CHWs), resulting in low adherence. Electronic IMCI (eIMCI) platforms with training modules may address these limitations but require further evaluation.
Objective:
This study aims to evaluate an eIMCI platform for training support and disease management in rural China.
Methods:
A cluster randomized controlled trial was conducted in western China. 24 CHWs and 72 children aged 2-5 years treated by them (3 per CHW) were randomized into intervention and control groups. The intervention group received online training and used the eIMCI platform for disease management. The control group received traditional in-person training and paper-based IMCI. The primary outcome was the proportion of children correctly diagnosed/classified by the CHWs as deemed by a pediatric specialist. Poisson regression with Generalized Linear Models estimated the relative risk (RR) between groups, adjusting for CHW clustering, CHW variables (age, sex, education), and patient variables (age, sex, disease number).
Results:
13 CHWs treated 39 children in the intervention group, and 11 CHWs treated 33 children in the control group. Correct classification was significantly higher in the intervention versus control group (64.1% vs 39.4%, P=.036). Multivariable regression confirmed this improvement (RR=2.10, 95% CI: 1.45-3.06; P<.001). Correct treatment increased non-significantly (38.5% vs 27.3%, P=.316). Online training reduced time and costs by ~80% but with a minor decline in post-training scores.
Conclusions:
With substantially lower training burden, the eIMCI platform demonstrated potential to improve IMCI in rural China. Clinical Trial: Chinese Clinical Trial Registry: ChiCTR2100042533 (https://www.chictr.org.cn/showproj.html?proj=119995)
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