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An Integrated eDiagnosis Approach (IeDA) versus standard IMCI for assessing and managing childhood illness in Burkina Faso: a stepped-wedge cluster randomised trial
Open accessAbstract
Background: The Integrated eDiagnosis Approach (IeDA), centred on an electronic Clinical Decision Support System (eCDSS) developed in line with national Integrated Management of Childhood Illness (IMCI) guidelines, was implemented in primary health facilities of two regions of Burkina Faso. An evaluation was performed using a stepped-wedge cluster randomised design with the aim of determining whether the IeDA intervention increased Health Care Workers’ (HCW) adherence to the IMCI guidelines. Methods: Ten randomly selected facilities per district were visited at each step by two trained nurses: One observed under-five consultations and the second conducted a repeat consultation. The primary outcomes were: overall adherence to clinical assessment tasks; overall correct classification ignoring the severity of the classifications; and overall correct prescription according to HCWs’ classifications. Statistical comparisons between trial arms were performed on cluster/step-level summaries. Results: On average, 54 and 79% of clinical assessment tasks were observed to be completed by HCWs in the control and intervention districts respectively (cluster-level mean difference = 29.9%; P-value = 0.002). The proportion of children for whom the validation nurses and the HCWs recorded the same classifications (ignoring the severity) was 73 and 79% in the control and intervention districts respectively (cluster-level mean difference = 10.1%; P-value = 0.004). The proportion of children who received correct prescriptions in accordance with HCWs’ classifications were similar across arms, 78% in the control arm and 77% in the intervention arm (cluster-level mean difference = − 1.1%; P-value = 0.788). Conclusion: The IeDA intervention improved substantially HCWs’ adherence to IMCI’s clinical assessment tasks, leading to some overall increase in correct classifications but to no overall improvement in correct prescriptions. The largest improvements tended to be observed for less common conditions. For more common conditions, HCWs in the control districts performed relatively well, thus limiting the scope to detect an overall impact. Trial registration: ClinicalTrials.gov NCT02341469; First submitted August 272,014, posted January 19, 2015.
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In real-world settings, the availability of data, logistical constraints, and variability in cluster sizes can complicate sample size calculations.
“In real-world settings, the availability of data, logistical constraints, and variability in cluster sizes can complicate sample size calculations (101).”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [101]
Methods > Sample size accounts for clustering and between-cluster variation and calculates power under two different numbers of children seen per facility. Methods > Data collection describes limits on visit duration, and Discussion > Limitations notes a departure from the planned design, but the paper does not say that data availability or logistical constraints complicated its sample-size calculations. No page numbers are provided in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredStudies such as those by Dorothy Thomas and Sophie Sarrassat exemplify how SWD can support multi-site implementation under real-world constraints.
“Studies such as those by Dorothy Thomas and Sophie Sarrassat exemplify how SWD can support multi-site implementation under real-world constraints (40, 101), consistent with broader methodological observations (2, 3, 15, 113).”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [101]
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References 29 · Cited by 61
Research works printed but not linked: 25
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Metadata
- Authors
- Sarrassat, S., Lewis, J. J., Some, A. S., Somda, S., Cousens, S., & Blanchet, K.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Cardiff University (GB)
- Centre Muraz (BF)
- Corresponding author
- Sarrassat, Sophie
- Venue
- BMC Health Services Research
- Published
- 2021-04-16
- Volume
- 21
- Issue
- 1
- Pages
- 354-354
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC8052659
- OpenAlex
- W3154274537
- Cited by
- 61
- References
- 29
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 14 · 2023: 10 · 2022: 8 · 2021: 2
- FWCI
- 7.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Bill and Melinda Gates Foundation (OPP1084359)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- Integrated Management of Childhood Illness, childhood diseases, prescribing accuracy, primary health centers, Burkina Faso
- MeSH terms
- Burkina Faso, Child, Child Health Services, Health Personnel, Humans, Referral and Consultation, Delivery of Health Care, Integrated
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