{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:52:33Z","timestamp":1792788753460,"version":"4.5.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Save the Children International (UK) Beijing Representative Office","id":[{"id":"https:\/\/ror.org\/02y2gng66","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Objectives<\/jats:title>\n The Integrated Management of Childhood Illness (IMCI) faces challenges in capacity building and quality control. This trial aims to assess an electronic IMCI (eIMCI) platform in improving the effectiveness and efficiency in disease classification and management by community health workers (CHWs).<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Cluster randomized controlled trial.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Rural western China.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n 24 CHWs and 72 ill children aged 2 months to 5 years (3 children per CHW). CHWs were randomly assigned to intervention or control groups.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n The intervention CHWs received online training and performed disease management using the eIMCI platform featuring integrated training modules and decision-support tools. The control group received traditional face-to-face training and used paper-based IMCI protocols.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Proportion of children correctly diagnosed or classified by CHWs, as determined by a pediatric specialist. Relative risk (RR) between groups was estimated using Poisson Generalized Linear Mixed Models incorporating a random intercept for CHW to account for clustering of children within individual CHWs and adjusting for key covariates at both the CHW and child levels.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The intervention group (13 CHWs, 39 children) had a higher rate of correct classification (64.1%) compared to the control group (11 CHWs, 33 children) (39.4%, P\u2009=\u2009.056). Multivariable regression analysis confirmed this (RR\u2009=\u20092.1, 95% CI: 1.5\u20133.1; P\u2009<\u2009.001). No significant difference was found in correct treatment rates (38.5% vs. 27.3%, P\u2009=\u2009.316). Online training reduced time and costs by approximately 80%, though with a slight decrease in post-training evaluation scores.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The eIMCI platform shows potential in enhancing IMCI implementation and significantly reducing the training burden in resource-limited settings.<\/jats:p>\n \n Trial registration:<\/jats:bold>\n Chinese Clinical Trial Registry: ChiCTR2100042533,\n https:\/\/www.chictr.org.cn\/showproj.html?proj=119995<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0352583","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:45:11Z","timestamp":1789494311000},"page":"e0352583","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the accuracy and efficiency of an electronic platform for managing childhood illnesses in rural China: A cluster randomized controlled trial"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4610-9848","authenticated-orcid":true,"given":"Puhong","family":"Zhang","sequence":"first","affiliation":[{"name":"China Office","place":["Beijing, China"],"department":["The George Institute for Global Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhao","sequence":"additional","affiliation":[{"name":"China Office","place":["Beijing, China"],"department":["The George Institute for Global Health"]},{"name":"National University of Singapore","place":["Singapore, Singapore"],"department":["Duke-NUS Medical School"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Shang","sequence":"additional","affiliation":[{"name":"China Office","place":["Beijing, China"],"department":["The George Institute for Global Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duolikun","family":"Nadila","sequence":"additional","affiliation":[{"name":"China Office","place":["Beijing, China"],"department":["The George Institute for Global Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Li","sequence":"additional","affiliation":[{"name":"Capital Institute of Paediatrics","place":["Beijing, China"],"department":["Child Health Big Data Research Center"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Liu","sequence":"additional","affiliation":[{"name":"Beihang University","place":["Beijing, China"],"department":["School of Computer Science and Engineering"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulizat","family":"Abdurixit","sequence":"additional","affiliation":[{"name":"Save the Children","place":["Xinjiang, China"],"department":["Xinjiang Programme"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane Elizabeth","family":"Hirst","sequence":"additional","affiliation":[{"name":"University of Oxford","place":["Oxford, United Kingdom"],"department":["Nuffield Department of Women\u2019s & Reproductive Health"]},{"name":"Imperial College London","place":["London, United Kingdom"],"department":["The George Institute for Global Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"pone.0352583.ref001","author":"United Nations Children\u2019s Fund, World Health Organization, World Bank Group.","year":"2020"},{"key":"pone.0352583.ref002","author":"National Health Commission of the People\u2019s Republic of China.","year":"2019"},{"issue":"6","key":"pone.0352583.ref003","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1136\/adc.75.6.468","article-title":"Integrated management of childhood infections and malnutrition: a global initiative","volume":"75","author":"H Campbell","year":"1996","journal-title":"Arch Dis Child"},{"issue":"9445","key":"pone.0352583.ref004","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1016\/S0140-6736(04)17311-X","article-title":"Effectiveness and cost of facility-based Integrated Management of Childhood Illness (IMCI) in Tanzania","volume":"364","author":"JRM Armstrong Schellenberg","year":"2004","journal-title":"Lancet"},{"key":"pone.0352583.ref005","author":"World Health Organization."},{"issue":"9377","key":"pone.0352583.ref006","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S0140-6736(03)13811-1","article-title":"How many child deaths can we prevent this year?","volume":"362","author":"G Jones","year":"2003","journal-title":"Lancet"},{"issue":"6","key":"pone.0352583.ref007","article-title":"Does integrated management of childhood illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis","volume":"8","author":"DTK Nguyen","year":"2013","journal-title":"PLoS One"},{"key":"pone.0352583.ref008","author":"World Health Organization","year":"2016"},{"issue":"6","key":"pone.0352583.ref009","article-title":"Integrated management of childhood illness (IMCI) strategy for children under five","volume":"2016","author":"T Gera","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"pone.0352583.ref010","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1093\/heapol\/czp054","article-title":"The rise and fall of supervision in a project designed to strengthen supervision of Integrated Management of Childhood Illness in Benin","volume":"25","author":"AK Rowe","year":"2010","journal-title":"Health Policy Plan"},{"issue":"6","key":"pone.0352583.ref011","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1136\/archdischild-2013-305863","article-title":"Mentoring and quality improvement strengthen integrated management of childhood illness implementation in rural Rwanda","volume":"100","author":"H Magge","year":"2015","journal-title":"Arch Dis Child"},{"key":"pone.0352583.ref012","article-title":"Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness","volume":"20","author":"MCE-IMCI Technical Advisors","year":"2005","journal-title":"Health Policy Plan"},{"issue":"4","key":"pone.0352583.ref013","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1136\/archdischild-2011-301191","article-title":"Integrated management of childhood illness: what have we learned and how can it be improved?","volume":"97","author":"M Chopra","year":"2012","journal-title":"Arch Dis Child"},{"issue":"2","key":"pone.0352583.ref014","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.healthpol.2010.01.013","article-title":"National implementation of Integrated Management of Childhood Illness (IMCI): policy constraints and strategies","volume":"96","author":"HM Ahmed","year":"2010","journal-title":"Health Policy"},{"issue":"9876","key":"pone.0352583.ref015","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1016\/S0140-6736(13)60314-1","article-title":"Bottlenecks, barriers, and solutions: results from multicountry consultations focused on reduction of childhood pneumonia and diarrhoea deaths","volume":"381","author":"CJ Gill","year":"2013","journal-title":"Lancet"},{"issue":"12","key":"pone.0352583.ref016","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1136\/archdischild-2019-317072","article-title":"Review of Integrated Management of Childhood Illness (IMCI) in 16 countries in Central Asia and Europe: implications for primary healthcare in the era of universal health coverage","volume":"104","author":"S Carai","year":"2019","journal-title":"Arch Dis Child"},{"key":"pone.0352583.ref017","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.socscimed.2013.12.020","article-title":"Why don\u2019t clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)?","volume":"104","author":"S Lange","year":"2014","journal-title":"Soc Sci Med"},{"issue":"2","key":"pone.0352583.ref018","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2471\/BLT.08.050740","article-title":"Why first-level health workers fail to follow guidelines for managing severe disease in children in the Coast Region, the United Republic of Tanzania","volume":"87","author":"ND Walter","year":"2009","journal-title":"Bull World Health Organ"},{"issue":"7","key":"pone.0352583.ref019","article-title":"New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): a controlled non-inferiority study on clinical outcome and antibiotic use in Tanzania","volume":"10","author":"AF Shao","year":"2015","journal-title":"PLoS One"},{"issue":"1","key":"pone.0352583.ref020","doi-asserted-by":"crossref","first-page":"249","DOI":"10.4269\/ajtmh.15-0395","article-title":"Performance of health workers using an electronic algorithm for the management of childhood illness in Tanzania: a pilot implementation study","volume":"96","author":"C Rambaud-Althaus","year":"2017","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0352583.ref021","doi-asserted-by":"crossref","DOI":"10.2196\/25777","article-title":"Effectiveness of smartphone-based community case management on the urgent referral, reconsultation, and hospitalization of children aged under 5 years in Malawi: cluster-randomized, stepped-wedge trial","volume":"23","author":"GB Chirambo","year":"2021","journal-title":"J Med Internet Res"},{"issue":"1","key":"pone.0352583.ref022","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1186\/s12887-022-03282-6","article-title":"Evaluation of community health worker\u2019s performance at home-based newborn assessment supported by mHealth in rural Bangladesh","volume":"22","author":"F Jahan","year":"2022","journal-title":"BMC Pediatr"},{"key":"pone.0352583.ref023","article-title":"Evaluation of symptom checkers for self diagnosis and triage: audit study","volume":"351","author":"HL Semigran","year":"2015","journal-title":"BMJ"},{"issue":"1","key":"pone.0352583.ref024","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1186\/s12913-021-06317-3","article-title":"An Integrated eDiagnosis Approach (IeDA) versus standard IMCI for assessing and managing childhood illness in Burkina Faso: a stepped-wedge cluster randomised trial","volume":"21","author":"S Sarrassat","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"pone.0352583.ref025","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/1472-6947-13-95","article-title":"Using electronic technology to improve clinical care - results from a before-after cluster trial to evaluate assessment and classification of sick children according to Integrated Management of Childhood Illness (IMCI) protocol in Tanzania","volume":"13","author":"M Mitchell","year":"2013","journal-title":"BMC Med Inform Decis Mak"},{"key":"pone.0352583.ref026","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.cmi.2018.04.014","article-title":"Electronic clinical decision algorithms for the integrated primary care management of febrile children in low-resource settings: review of existing tools","volume":"24","author":"K Keitel","year":"2018","journal-title":"Clin Microbiol Infect"},{"key":"pone.0352583.ref027","author":"Chinese Health Commission.","year":"2017"},{"issue":"4","key":"pone.0352583.ref028","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.3390\/ijerph18042013","article-title":"Influential factors of burnout among village doctors in China: a cross-sectional study","volume":"18","author":"X Zhao","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0352583.ref029","volume-title":"Design and analysis of cluster randomization trials in health research","author":"n Donner A l l a","year":"2000"},{"key":"pone.0352583.ref030","doi-asserted-by":"crossref","DOI":"10.4324\/9780203803738","volume-title":"Handbook of distance education","author":"MG Moore","year":"2013"},{"issue":"4","key":"pone.0352583.ref031","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0321781","article-title":"Needs satisfaction and online self-regulated learning among chinese undergraduates","volume":"20","author":"X Zhou","year":"2025","journal-title":"PLoS One"},{"key":"pone.0352583.ref032","author":"World Health Organization.","year":"2025"},{"issue":"1","key":"pone.0352583.ref033","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s12887-022-03147-y","article-title":"The feasibility and ongoing use of electronic decision support to strengthen the implementation of IMCI in KwaZulu-Natal, South Africa","volume":"22","author":"C Jensen","year":"2022","journal-title":"BMC Pediatr"},{"key":"pone.0352583.ref034","doi-asserted-by":"crossref","DOI":"10.1017\/S1463423619000380","article-title":"Treatment by untrained providers among sick infants in rural Odisha, India","volume":"20","author":"M Samal","year":"2019","journal-title":"Prim Health Care Res Dev"},{"issue":"1","key":"pone.0352583.ref035","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1186\/s12913-020-05344-w","article-title":"Smart triage: triage and management of sepsis in children using the point-of-care Pediatric Rapid Sepsis Trigger (PRST) tool","volume":"20","author":"A Mawji","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"pone.0352583.ref036","author":"World Health Organization"},{"issue":"1","key":"pone.0352583.ref037","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12913-022-09001-2","article-title":"Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses\u2019 experiences of using an electronic clinical decision support system (CDSS) in South Africa","volume":"23","author":"C Horwood","year":"2023","journal-title":"BMC Health Serv Res"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352583","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:45:21Z","timestamp":1789494321000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352583"}},"subtitle":[],"editor":[{"given":"Cho Lee","family":"Wong","sequence":"first","affiliation":[{"name":"The Chinese University of Hong Kong","place":["HONG KONG"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0352583","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}