This community innovation has been accepted at the 2025 DHIS2 Annual Conference
Designing a diagnosis support system for Child TB
Background : Childhood tuberculosis remains a major global health issue, particularly in low and middle income countries (LMICs), where over one million children develop the disease annually. Childhood tuberculosis remains largely undiagnosed due to inadequate diagnostic tools at primary healthcare and district hospital levels. The World Health Organization recommends treatment decision algorithms (TDAs) to standardize and decentralize diagnosis, but their adoption by healthcare workers (HCWs) remains a challenge. Digital health interventions, particularly electronic medical records integrated with clinical decision support systems (CDSS), can improve diagnostic decision making. Despite multiple digital health initiatives in low resource settings, few have focused on implementing a CDSS for childhood tuberculosis. The challenge is developing sustainable, scalable digital solutions that integrate effectively into existing health systems. This study describes the development and implementation of a DHIS2 based electronic medical record incorporating a CDSS to enhance the use of TDAs in Mozambique and Zambia. Method: A contextual design approach engaged national tuberculosis programs (NTPs) and HCWs. Implemented in ten districts across Zambia and Mozambique, the pilot phase covered three districts. Researchers and NTPs identified essential data variables, selecting DHIS2 for its flexibility. A program tracker with 19 stages, including automated score calculation and diagnostic guidance, was developed with 170 rules. The system was deployed on tablets for real time and offline data entry. HCWs received structured training and a user guide. Usability testing included 10 tasks, the System Usability Scale (7 HCWs), and the Think Aloud protocol (4 HCWs). Conclusion: HCWs reported 90% task completion but faced usability challenges due to digital literacy, DHIS2 limitations, and redundancy. Ongoing evaluations will assess interoperability, emphasizing digital literacy training and iterative usability
Primary Author: Cleia Etoa
Keywords:
Clinical support system, Childhood Tuberculosis, Digital Health, treatment decision algorithm, DHIS2, usability, Digital intervention