Framework of clinical decision support solutions for enabling knowledge sharing in the management of acute child malnutrition in Uganda

Abstract

Acute Child Malnutrition (ACM) in Uganda is a major public concern and leading cause of death among children who are below the age of five years. There are several attempts to address the disease through the establishment of the National Referral Center (Mwanamugimu Nutrition Unit) and Integrated Management of Acute Malnutrition (IMAM) guidelines to guide treatment of ACM in different health facilities. However, the burden of ACM patients is too overwhelming to be managed by only healthcare professionals at the National Referral Center and a few other centers. This is caused by the existence of knowledge gaps in management and treatment of ACM, among health workers in sub-national and lower health facilities. Yet the National Referral Center and a few other specialized centers have experts who are very knowledgeable in managing and treating ACM. This knowledge gap problem at lower health facilities has led to challenges such as poor quality of care for ACM patients, poor case management, increased mortality rates, and increased referrals to the National Referral Center (which brings about congestion and poor adherence to national guidelines for managing malnutrition). Knowledge Management frameworks and Clinical Decision Support Systems are often reported to address knowledge gap issues in the management of various health conditions. However, they have not been used to address challenges that hinder effective management of ACM. Thus, they were identified as potential solutions that could be mutually adapted to address the problems encountered in managing and treating ACM. To explore their feasibility as potential solutions, this study set out to develop a Framework of Clinical Decision Support Solutions for Enabling Knowledge Sharing in the Management of Acute Child Malnutrition in Uganda (CLISAM). To develop CLISAM, Design Science research method was adopted, and five major research activities were executed as summarized below. First, a survey was conducted among healthcare professionals (in Mwanamugimu Nutrition Unit and Nalufenya children’s hospital), to confirm and investigate challenges hindering effective management and treatment of ACM. Second, findings from the survey were used to generate requirements for a CLISAM. Third, CLISAM was designed by mutually adopting a Knowledge Management Cycle and a Clinical Decision Support Framework. CLISAM design is presented using two views – a high level view that shows the 5 stages that constitute CLISAM; and the detailed view that shows elements that constitute each of the 5 stages. The detailed view also shows supporting elements of CLISAM, which include: factors that influence knowledge sharing, Government factors, monitoring & evaluation of ACM management in health facilities and supporting healthcare information systems for both health facilities and the general community. Accordingly, the CLISAM framework comprises at least five software modules or components, where the core module focuses on supporting knowledge sharing among health workers when treating and managing ACM. Thus, the Fourth research activity involved defining system requirements and specifications for only the core module of CLISAM. Fifth, the design of CLISAM and the system requirements of its core module were evaluated by using structured walkthroughs to engage healthcare professionals who are specialists in managing ACM at Mwanamugimu Nutrition Unit; and informatics experts at Makerere University. The evaluation findings revealed that: the purpose of CLISAM is understandable and its narrative presentation is understandable. Healthworkers also agreed that CLISAM will address majority of the challenges encountered in the management of ACM like enabling nutritional knowledge sharing, bridging health facility –community linkage and enforcing usage (adherence) of IMAM guidelines issued by Ministry of Health