Clinical decision support algorithm to optimize management of respiratory tract infection in children attending primary health facilities in Kilimanjaro Region, Tanzania

用于优化坦桑尼亚乞力马扎罗地区初级卫生机构儿童呼吸道感染管理的临床决策支持算法

• 批准号: 10734148
• 负责人: James Samwel Ngocho
• 金额: $ 7.8万
• 依托单位: KILIMANJARO CHRISTIAN MEDICAL CENTRE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10734148
• 关键词: 5 year old; Acceleration; Address; Africa; Africa South of the Sahara; African; Algorithms; Ambulatory Care; Anti-Bacterial Agents; Antibiotic Resistance; Antibiotics; Antimicrobial Resistance; Area; Asia; Attitude; Award; Behavioral Sciences; Biological Markers; Caregivers; Case Management; Characteristics; Child; Child Health; Childhood; Clinical; Clinical Research; Cohort Studies; Collaborations; Communicable Diseases; Country; Data; Data Science; Dedications; Diagnosis; Disease; Disease Management; Environment; Epidemiology; Etiology; Evaluation; Exposure to; Feasibility Studies; Funding; Future; Gambia; Genes; Goals; Health Personnel; Health care facility; High Prevalence; Hospitalization; Human; Infectious Disease Epidemiology; Infectious Diseases Research; Intervention; K-Series Research Career Programs; Life; Lower Respiratory Tract Infection; Lower respiratory tract structure; Mali; Medical; Medical Education; Medical center; Mentors; Mentorship; Messenger RNA; Methodology; Methods; Outpatients; Patient Care; Patients; Performance; Pneumonia; Primary Care; Program Development; Public Health; Research; Research Personnel; Resources; Respiratory Tract Infections; Risk; Running; Safety; Sampling; Serum Proteins; Severity of illness; Site; Social Behavior; South Africa; Specificity; Syndrome; Tanzania; Teacher Professional Development; Testing; Time; Training; Training Programs; United States National Institutes of Health; Universities; Viral; Viral Respiratory Tract Infection; Virus; Visit; Work; algorithm development; care providers; career; career development; clinical decision support; clinical decision-making; clinical epidemiology; clinical examination; clinical practice; clinical predictors; cohort; design; early childhood; efficacy testing; evidence base; expectation; experience; health care service utilization; health empowerment; human centered design; improved; infection management; innovation; low and middle-income countries; mortality; novel marker; point of care; preventable death; prognostic; programs; prospective; protein biomarkers; research study; risk stratification; skill acquisition; skills; social science research; support tools; therapy design; therapy development; tool; user-friendly

Abstract In low- and middle-income countries (LMICs), respiratory tract infections (RTIs) are a leading cause of preventable death among young children (< 5 years of age). Severe RTIs, usually involving the lower respiratory tract, constitute a potentially life-threatening medical problem that requires effective diagnosis and management, including evaluation for antibacterials. At the same time, the vast majority of RTIs in young children are non-severe and often caused by viruses. For these exceedingly common, non-severe viral RTI cases, antibacterials are not appropriate and could cause harm. Yet in LMICs of Africa and Asia, research studies have shown that antibacterials are prescribed for over 75% of outpatient pediatric RTI visits. RTI management is thus highly problematic: on the one hand, a common syndrome that is grossly over-treated with inappropriate antibacterials; on the other hand, clinicians in low-resourced LMIC settings can understandably be concerned that withholding antibacterials could run the risk of a pediatric RTI progressing to a severe, life-threatening condition. This K43 application presents a career development program to 1) develop a clinical prediction rule that uses a parsimonious composite of clinical covariates and novel biomarkers to accurately differentiate viral from bacterial RTI and to provide prognostic risk stratification of disease severity in young children presenting to health facilities in Kilimanjaro Region, Tanzania; 2) conduct formative social science research to understand caregiver and healthcare provider expectations, attitudes and acceptability thresholds for withholding antibacterials in uncomplicated viral RTI; 3) use human-centered design methodology to package the prediction rule and the attitudes, expectations and needs of caregivers and healthcare providers into a user-friendly, effective clinical decision support algorithm that could be tested in future studies for feasibility, safety, and efficacy. The candidate for this career development award is a Tanzanian medical doctor with advanced training in clinical research, public health, and epidemiology. He has conducted clinical research on RTI in Tanzania since 2016. For this mentored research award, the candidate has assembled an exceptional team of mentors with expertise in clinical-epidemiologic research of infectious diseases in Tanzania, clinical prediction analysis, human-centered intervention design in Tanzania and other LMICs, as well as a collaborator with expertise in algorithm development for innovative approaches to RTI management in LMICs. At the conclusion of this award, the candidate will have developed unique expertise 1) in clinical prediction for infectious disease management in sub-Saharan Africa and 2) in human-centered design of clinical decision support algorithms. He will emerge as a global leader in intervention design for management of infectious diseases—a highly-skilled independent investigator focused on implementation of strategies that will confront early childhood mortality and the growing threat of antimicrobial resistance.

摘要 在低收入和中等收入国家，呼吸道感染是导致 幼儿(&lt；5岁)可预防的死亡。严重的呼吸道感染，通常涉及较低的 呼吸道疾病是一种潜在威胁生命的医疗问题，需要有效的诊断 和管理，包括对抗菌药物的评估。与此同时，绝大多数的生殖器感染在年轻人中 儿童并不严重，通常是由病毒引起的。对于这些非常常见的、非严重的病毒性RTI 在某些情况下，抗菌药不合适，可能会造成危害。然而，在非洲和亚洲的LMIC中，研究 研究表明，在儿科RTI门诊就诊中，超过75%的患者使用了抗菌药物。RTI 因此，管理是非常有问题的：一方面，一种严重过度治疗的常见综合症 使用不适当的抗菌药物；另一方面，在低资源的LMIC环境中的临床医生可以 可以理解的是，担心停止服用抗菌药物可能会带来儿科RTI进展的风险 严重的、危及生命的情况。此K43应用程序向1)提供职业发展计划 开发一种临床预测规则，该规则使用临床协变量和新的 准确区分病毒和细菌性RTI并提供预后风险分层的生物标志物 坦桑尼亚乞力马扎罗地区卫生机构的幼儿疾病严重程度；2)行为 形成性社会科学研究，以了解照顾者和医疗保健提供者的期望、态度 以及在简单的病毒RTI中抑制抗菌药的可接受阈值；3)以人为中心 设计方法论来包装预测规则和照顾者的态度、期望和需求 和医疗保健提供者集成到用户友好、有效的临床决策支持算法中，该算法可以测试 在未来的可行性、安全性和有效性研究中。这一职业发展奖的候选人是 坦桑尼亚医生，受过临床研究、公共卫生和流行病学方面的高级培训。他 自2016年以来一直在坦桑尼亚进行RTI的临床研究。对于这个指导性研究奖， 候选人组建了一支具有临床流行病学研究专业知识的杰出导师团队 坦桑尼亚传染病的临床预测分析，以人为中心的干预设计 坦桑尼亚和其他LMIC，以及在创新的算法开发方面拥有专业知识的合作者 低成本集成电路中的RTI管理方法。在这个奖项结束时，候选人将会发展出 独特的专业知识1)撒哈拉以南非洲传染病管理的临床预测和2) 以人为本设计临床决策支持算法。他将成为一名全球领导者 传染病管理的干预设计--高技能的独立调查员 重点是执行应对幼儿死亡率和日益增长的威胁的战略 抗菌素耐药性。