Using a mobile application to improve pediatric presumptive TB identification in western Kenya
Daria Szkwarko, DO, MPH
BACKGROUND: Early recognition of TB symptoms in children is critical in order to link children to appropriate TB treatment and decrease complications. Healthcare workers in pediatric outpatient clinics in limited resources settings like Webuye County Hospital in western Kenya are often overburdened with competing clinical priorities, leading to incomplete symptom screening for presumptive TB.
GAP: The implementation of screening tools such as a presumptive pediatric TB mobile/tablet application show promise; however, although this tool has been implemented for care in both Bangladesh and Kenya, it has never been formally evaluated for feasibility, appropriateness, and effectiveness.
HYPOTHESIS: We hypothesize that the implementation of this user-centered designed presumptive pediatric TB mobile/tablet application will be feasible and appropriate in our setting.
We hypothesize that the proportion of presumptive TB patients and pediatric TB cases identified in outpatient clinics will significantly increase with the use of the presumptive pediatric TB mobile/tablet application.
METHODS: Using a mixed-methods implementation science framework, we will first use a participatory, iterative approach to pilot and adapt the presumptive pediatric TB mobile/tablet application based on feedback from healthcare workers in pediatric outpatient clinics in a county hospital in western Kenya. We will review data for children < 15 years who attended pediatric outpatient clinic, nutrition clinic, casualty, child welfare clinics and other pediatric outpatient areas before and after the implementation of the mobile application, and we will compare the number of children identified in the paper presumptive TB registers.
RESULTS: Since the implementation of the mobile application, 3446 children have been screened for presumptive TB in the outpatient clinics at Webuye County Hospital. Preliminary data comparing a pre-intervention period (August-December 2018) to the intervention period (August-December 2019) demonstrated an increase in the proportion of pediatric TB cases identified (13.5% vs. 16.9% respectively). Remaining results are pending.
IMPACT: This study will provide preliminary data regarding the effectiveness of a CHV led presumptive pediatric TB mobile application, thereby laying the groundwork for a multi-site trial to test this mobile application and identify an evidence-based strategy to ultimately decrease the burden of pediatric TB globally.