Evaluating a mobile health tool to improve management of pediatric acute respiratory illness in Uganda

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Candidate: Dr. Ellington is a pediatric pulmonologist at the University of Washington (UW) and K12 UW-Implementation Science Training Grant recipient (NHLBI). She completed a Master of Science in Epidemiology at the UW School of Public Health and has a long-term track record of successful global health research. Dr. Ellington’s long-term goal is to become an independent physician-investigator working to improve health outcomes of pediatric respiratory conditions in resource-constrained settings. Her career development plan includes coursework, experiential learning, and mentorship to achieve training goals in 1) complex qualitative and mixed methods, 2) pragmatic clinical trials and quasi- experimental studies, 3) advanced implementation science, and 4) global health leadership. Environment: The proposed training and research activities will be facilitated by existing strong international collaborations, resources, infrastructure, and academically rigorous environments of the UW Schools of Medicine and Public Health and the Makerere University Lung Institute and College of Computing & Information Science. Research: Acute lower respiratory illnesses (ALRI) are a leading cause of childhood mortality in children under 5 years, despite effective prevention and treatment strategies. The majority of deaths occur in sub-Saharan Africa. Major challenges in case management exist in low- and middle-income countries (LMICs), including poor adherence to ALRI guidelines, lack of health worker training, and lack of decision support to recognize wheezing illnesses (asthma and bronchiolitis), which represent up to 50% of ALRI in children. Acute Lower Respiratory Illness Treatment Evaluation (ALRITE) is a comprehensive guideline- and evidence-based ALRI clinical decision support mobile health tool Dr. Ellington developed with her team. ALRITE has demonstrated preliminary acceptability and usability in Ugandan health centers but requires optimization for health system integration and pilot-testing in clinical care. Dr. Ellington proposes a feasibility study in 4 Ugandan health centers to 1) identify promising implementation strategies for the ALRITE intervention to optimize implementation, 2) pilot-test study feasibility of the ALRITE tool and its effectiveness for diagnosis and management of wheezing illness and pneumonia in children 1-59 months using an interrupted time series design, and 3) assess the outcomes of implementation following ALRITE deployment and barriers/facilitators of ALRITE use. Successful completion of these aims will improve implementation of decision support tools in Uganda and other LMICs, provide critical preliminary data to support Dr. Ellington’s planned R01 for a cluster RCT evaluating clinical effectiveness of the ALRITE intervention in LMICs, and provide Dr. Ellington with the training and experience needed to transition to research independence.