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，其中大多数发生在 低收入和中等收入国家（LMIC）。然而，治疗腹泻的基础是补液， 抗菌剂在某些情况下是有益的。不幸的是，由于治疗往往是经验性的， 大多数临床上怀疑是细菌引起的，抗菌药物被过度用于治疗腹泻 世界各地的疾病因此，需要临床决策支持工具来告知临床管理和 促进抗菌管理。特别是，农村地区的一线医疗保健提供者， 孟加拉国的医生通常对抗菌药物使用的基础知识不足， 大的指导。我们最近开发了一种基于移动的电话的电子临床决策支持系统 工具（eCDST），并显示了病原学预测对医生抗生素处方实践的影响， 两个中低收入国家的儿童腹泻。在本提案中，我们的总体目标是将我们的eCDST定制为 综合移动健康应用（腹泻病因预测工具，ADEPT），以支持农村 卫生保健提供者在儿科腹泻的管理（R21阶段），并衡量其影响，通过 可行性研究（R33阶段）试点前后的表现。我们的工作将有助于证明 移动健康支持的抗菌药物管理的基础，有可能扩展到非传染性疾病， 其他综合征，包括呼吸道疾病和发热性疾病。

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.