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Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting
Farhana Haque | Robyn L. Ball | Selina Khatun | Mujaddeed Ahmed | Saraswati Kache | Mohammod Jobayer Chisti | Shafiqul Alam Sarker | Stace D. Maples | Dane Pieri | Teja Vardhan Korrapati | Clea Sarnquist | Nancy Federspiel | Muhammad Waliur Rahman | Jason R. Andrews | Mahmudur Rahman | Eric Jorge Nelson
Date of Publication:
PLoS neglected tropical diseases
Diarrheal disease is responsible for one in ten deaths among children less than five years of age globally. Innovative interventions to address gaps in the clinical care of these patients are lacking, yet will likely reduce the morbidity and mortality from diarrheal diseases. Therefore, the objective of this pilot study was to take a technology-enabled approach to improve guideline adherence, including antibiotic selection for diarrheal disease management in a resource-limited setting. To do this we adapted WHO guidelines to a smartphone platform and evaluated the approach in Bangladesh at two rural hospitals. The platform was durable and demonstrated positive improvement in guideline adherence. The results suggest that the decision-support tool was associated with a decrease in intravenous fluid use while maintaining safety, an increase in use of the recommended antibiotic, and a decrease in use of medications not recommended. This study represents a critical first step towards technology-enabled decision-support tools for diarrheal disease in resource-limited settings.
Community Mortality from Cholera: Urban and Rural Districts in Zimbabwe
D. Morof | S. T. Cookson | S. Laver | D. Chirundu | S. Desai | P. Mathenge | D. Shambare | L. Charimari | S. Midzi | C. Blanton | T. Handzel
Date of Publication:
American Journal of Tropical Medicine and Hygiene
In 2008–2009, Zimbabwe experienced an unprecedented cholera outbreak with more than 4,000 deaths. More than 60%of deaths occurred at the community level.We conducted descriptive and case–control studies to describe community deaths. Cases were in cholera patients who died outside health facilities. Two surviving cholera patients were matched by age, time of symptom onset, and location to each case-patient. Proxies completed questionnaires regarding mortality risk factors. Cholera awareness and importance of rehydration was high but availability of oral rehydration salts was low. A total of 55 case-patients were matched to 110 controls. The odds of death were higher among males (adjusted odd ratio [AOR] = 5.00, 95% confidence interval [CI] = 1.54–14.30) and persons with larger household sizes (AOR = 1.21, 95%CI = 1.00–1.46). Receiving home-based rehydration (AOR = 0.21, 95% CI = 0.06–0.71) and visiting cholera treatment centers (CTCs) (AOR = 0.07, 95% CI = 0.02–0.23) were protective. Receiving cholera information was associated with home-based rehydration and visiting CTCs.When we compared cases and controls who did not go to CTCs, males were still at increased odds of death (AOR = 5.00, 95% CI = 1.56–16.10) and receiving home-based rehydration (AOR =0.14, 95% CI = 0.04–0.53) and being married (AOR = 0.26, 95% CI = 0.08–0.83) were protective. Inability to receive home-based rehydration or visit CTCs was associated with mortality. Community education must reinforce the importance of prompt rehydration and CTC referral.