Forty one thousand children died before reaching their fifth birthday in Malawi in 2013. Over half of these deaths were caused by illnesses (sepsis, meningitis, pneumonia and diarrhoea) that are bothpreventable and treatable with early recognition and intervention.
In the absence of systematic triage at primary health level in Malawi, a common challenge is lack of early and accurate recognition of serious illness for urgent referral to hospital. Patients are seen on a first-come, first-served basis. Severe illnesses are regularly missed as hundreds of children queue for hours. Many do not survive the wait.
动作脑膜炎的发射
Action Meningitis launched in October 2012 and aims to tackle Malawi’s high infant mortality rate by introducing triage into primary clinics. Underpinned by ten years of clinical research and working closely with the Ministry of Health and other partners: the Malawi- Liverpool-Wellcome Trust, Queen Elizabeth Central Hospital and D-tree International, the project has successfully integrated an mHealth point-of-care triage system at primary level.
使用WHO紧急分类和治疗（ETAT）方案，医护人员（健康监视助手）可以检测到严重疾病的生命体征。
ETAT complements existing protocols and strengthens the overall healthcare system through improved prioritisation of care and resources. Children are given the attention and treatment they would otherwise miss due to overcrowding of clinics and lack of trained healthcare workers.
Introducing the mobile app for healthcare workers
One hundred and ninety two healthcare workers have been trained in the use of ETAT in eight clinics using the mHealth tool – a mobile phone. Through them triage was delivered to 220,000 children over two years.
诊所中的患者流量从根本上得到了改善，从而可以治疗生病的儿童或转诊到医院。在基线和终点研究中使用了定性和定量数据收集方法，以检查医疗工作者中临床实践和知识的变化。
所有初级中心的分类质量均保持较高（与重新检查儿童的ETAT临床医生的平均92.2±7.08％一致）。频繁的监测访问表明，诊所内有良好的患者流动，并以优先级的顺序看到患者。
手机是一个重要的工具，可确保医护人员坚持协议，并促使人们确定严重患病的孩子。分流器快速播放手机，需要不到一分钟的时间来评估每个孩子。在少数情况下，电话不可用（例如，在培训课程中使用），医护人员仍然继续运用他们学到的技能，并在没有手机的情况下在队列中分类儿童。
Improving the clinic experience with mHealth
Clinic waiting times remain encouraging for introduction of a system that prioritises according to severity of illness. Time taken to be seen by the clinician was on average significantly shorter for emergencies (9 minutes) than priorities (28 minutes) and longest for queue cases (31 minutes).
mHealth triage protocols are now integrated into three rural Primary Health Centres and District Hospital child health systems (previously non-existent). Chikhwawa District is very different from busy urban Blantyre, reflected in numbers of children attending clinics: on average 94 and 395 were triaged weekly per clinic in Chikhwawa and Blantyre, respectively.
The future of mHealth
在小学级别，更好的识别，治疗和转诊是降低儿童死亡率的关键重点。下一步是开发可扩展的解决方案，该解决方案可以在主要环境中采用，而现有合作伙伴正在与地方，区域和国家级卫生部紧密合作，以开发，完善，嵌入和扩展分流系统的范围。
脑膜炎研究基金会首席执行官Chris Head说：
“我们致力于在未来三年内与我们的合作伙伴和马拉维卫生部合作，以优化分类系统，以使其完全适合主要级别的干部员工，系统和资源（ETAT最初是在此设计和开发的马拉维的三级环境）。
Building on the success of the Chipatala Robot triage system we will expand further – training another 440 HCWs across 11 health centres, who will triage 384,000 children over the next three years. Our triaging system and the training we have provided to the health workers in Malawi means that seriously ill children are seen and treated sooner and we hope to save countless lives.”
脑膜炎研究基金会的视野是一个没有脑膜炎和败血病的世界。自从1989年成立以来，他们的专业知识已经帮助挽救了英国的数千人生命，现在他们正在马拉维分享这一专业知识。自2001年以来，脑膜炎研究基金会已向马拉维投资了70万英镑。
注释