MOBILE TECHNOLOGY TO IMPROVE TREATMENT, REPORTING, AND MONITORING FOR ACUTE MALNUTRITION

• Published in: Annals of nutrition and metabolism 2017-10, Vol.71 (Suppl. 2), p.783
• Main Authors: Emary, Colleen, O’Leary, Melani, Roschnik, Natalie, Keane, Emily, Frank, Tine, Snyder, Laura
• Format: Article
• Language: English
• Subjects: Acceptability; Adhesion; Applications programs; Childrens health; Communities; Community health care; Data processing; Energy consumption; Health; Malnutrition; Management; Management tools; Medical personnel; Medical treatment; Mobile computing; Protocol (computers); Software; Technology assessment; Workers
• ISSN: 0250-6807; 1421-9697
• DOI: 10.1159/000480486

Background and objectives: Community-based Management of Acute Malnutrition (CMAM) is a proven approach for treating acute malnutrition. Its effectiveness is undermined by poor adherence to clinical protocols, inaccurate record keeping and weak supervision systems. A mobile application (app) for CMAM was developed to provide health workers (HWs) with case management tools and job aids, including response-triggered decision tree algorithms, automated referral initiating and tracking, integrated media for counselling, and automated reporting. The app was contextualized and deployed in Afghanistan, Mali, Chad, Niger, and Kenya in 2014 to determine the effectiveness and impact of the technology. Methods: Evaluations were conducted in 2016 to assess the effect of the app on protocol adherence, monitoring, reporting, user acceptability and competency. Data was collected from a sampling of one third of implementation health centers and was matched with health centers using the traditional paper-based system for comparison. Evaluation tools included: Observational Checklist, Focus Group Discussions with HWs and beneficiaries, and Key Informant Interviews with project staff, Health District officials and Community health committee members. Monitoring tools administered quarterly, provided information on user acceptability and competency. Results: Data completeness, protocol adherence, and treatment outcomes were improved across all 5 countries and HW acceptability was high if they were given enough time, training and support. The main challenges to HW uptake were battery life, screen size, network speed/coverage, and requirement to complete dual reporting (electronic and paper-based). The app prevented skipping steps in treatment protocol, resulting in longer case management times. Conclusions: The app has demonstrated the potential to transform the delivery of CMAM, improving the ability to more efficiently and effectively treat acute malnutrition in humanitarian settings. However, developing 'global specifications' was not feasible given the differences between national protocols; country contextualization was complex and time consuming; field testing with users was vital; working with a technology partner who can accommodate timeline flexibility and works in fragile contexts would be beneficial; weak CMAM services in some countries affected uptake of the app. The app has also highlighted the need to better understand what is feasible in terms of capacity and tim