1066-India-Evaluation of Digital Tool for improving Integrated Management of Neonatal and Childhood Illness (IMNCI) uptake and quality of care at primary healthcare facilities for scale-up in Jharkhand, India

Integrated Management of Childhood Illness (IMCI) is a strategy for delivering key interventions that prevent and treat the most common causes of mortality in children under five years old, including neonatal infections, pneumonia, diarrhea, measles, malaria, and undernutrition. In India, the protocol was adapted as Integrated Management of Neonatal and Childhood Illness (IMNCI) to account for the change in the duration of training for health providers and 50% of that period of training being dedicated to newborns. Tdh introduced IeDA in India in 2020 as “e-IMNCI” and has worked with the government in Jharkhand state to deliver IMNCI by health care workers (HCWs) using mobile-based clinical decision support system (CDSS). Using mobile CDSS can potentially strengthen healthcare workers’ adherence to diagnosis and treatment protocols yielding better healthcare outcomes.

Given the mixed results on the effectiveness of such interventions, more robust study designs are needed to evaluate the effectiveness of such interventions. e-IMNCI has already been evaluated in a cross-sectional pilot study in the Ranchi district in India, which demonstrated the feasibility and acceptability of the approach within the Indian context (Alwadhi, et al, 2023).

We now propose conducting a randomized controlled trial to understand the effectiveness of e-IMNCI on quality of care outcomes. We also propose to study the fidelity of implementation of e-IMNCI in Jharkhand state and identifying factors that would affect its scale-up in the state and across India. This RCT, is, nested within an implementation research approach that aims to document barriers to effective adoption of the intervention.

We propose to intervene in 12 blocks and support 12 blocks as control. Healthcare providers in the intervention arm will use the e-IMNCI tool to provide care to sick children arriving at the health facilities. In addition to the tool deployment, trainings for providers on e-IMNCI and supportive supervision will be provided. On the other hand, providers in the control group will provide care to sick children using standard consultation techniques based on IMNCI protocols without digital support.

The student will receive support from the implementation partners (Tdh) to participate in e-IMNCI service delivery, capacity building for community health workers, and supportive supervision. The student will be undertaking primary data collection (in-depth interviews, direct observations, surveys) with support from in-country faculty (Dr. Suruchi Gupta, JHU) and local research partners (Dr. Arindam Das, IIHMR). This will be an immersive experience to learn about the Indian public healthcare system.

highly collaborative and supportive and allows building skills across clinical care, public health research, and digital health.

is interested in studying the role of digital tools in improving health outcomes.

Implementation science methods, qualitative interviewing, maternal and child health, clinical experience preferred

Name: Dr. Smisha Agarwal, sagarw23@jhu.edu

Dr. Diwakar Mohan, dmohan3@jhu.edu

Dr. Suruchi Gupta, suruchi@jhu.edu

I would describe my communication and mentorship styles as... 

Transparent, receptive, and collaborative. This project has several partners across Baltimore, India and local entities where the student will have an opportunity to learn alongside various members in a highly supportive environment. 

A complementary student would have a working style and mentorship expectations that are..

Open to learning, flexible, and wanting to take an intellectual lead on their work. 

Estimated Costs:

Housing: $300-500
Food: $200-300
Transportation: All project transport covered by the project
Internet: $12-15 
Total for 8 weeks: $500-800

Additional support from PI:

A stipend is available to offset costs.