A mobile health tool to improve antibiotic stewardship among village doctors in Bangladesh

摘要 腹泻病是全世界儿童死亡的主要原因之一，大多数发生在 中低收入国家(LMIC)。然而，治疗腹泻的基石是补充水分。 在某些情况下，抗菌剂是有益的。不幸的是，鉴于治疗通常是经验性的，基于 大多数临床怀疑是细菌引起的，抗菌药在腹泻的治疗中被过度使用。 世界范围内的疾病。因此，需要临床决策支持工具来通知临床管理和 推进抗菌药物监管。特别是农村地区的一线医疗保健提供者，如乡村 孟加拉国的医生往往对抗菌药物的使用基础知识不足，可能会受益 很大程度上来自于指导。我们最近开发了一种基于手机的电子临床决策支持系统 工具(ECDST)，并显示了病因学预测对医生抗生素处方实践的影响 两个LMICs的儿童腹泻。在此提案中，我们的首要目标是将我们的eCDST定制为 全面的mHealth应用程序(可访问的腹泻病原学预测工具，ADEPT)，支持农村 卫生保健提供者在儿童腹泻管理(R21阶段)中的作用，并通过以下方式衡量其影响 试点前后的绩效可行性研究(R33阶段)。我们的工作将有助于证明 为mHealth启用的抗菌素管理奠定基础，有可能超越腹泻疾病，进入 其他症状，包括呼吸道疾病和发烧疾病。

Abstract Diarrheal diseases are the among the leading cause of death in children worldwide, most of which occur in low- and middle-income countries (LMICs). The cornerstone for management of diarrhea is rehydration, though antimicrobials are beneficial in some instances. Unfortunately, given that treatment is frequently empiric, based mostly on clinical suspicion for bacterial causes, antimicrobials are overused in management of diarrheal illness worldwide. Thus, there is a need for clinical decision support tools to inform clinical management and promote antimicrobial stewardship. In particular, frontline healthcare providers in rural areas, such as village doctors in Bangladesh, often have inadequate knowledge for the basis of antimicrobial use, and may benefit greatly from guidance. We have recently developed a mobile phone based electronic clinical decision-support tool (eCDST), and shown the impact of etiological prediction on physician antibiotic prescription practices for pediatric diarrhea in two LMICs. In this proposal, our overarching goal is to customize our eCDST into a comprehensive mHealth application (Accessible Diarrhea Etiology Prediction Tool, ADEPT) to support rural health care providers in the management of pediatric diarrhea (R21 phase), and to measure its impact through the performance of a pilot before-after feasibility study (R33 phase). Our work will contribute to an evidence base for mHealth-enabled antimicrobial stewardship, with potential to extend beyond diarrheal illness, and into other syndromes, including respiratory illness and febrile illness.