Feasibility Testing of an Application to Improve the Diagnosis and Management of Febrile Illnesses by Frontline Health Workers in Low- and Middle-Income Countries

Abstract

<title>Abstract</title> Background The Febra Diagnostica App (Febra App) is an intelligent medical decision support system for diagnosing and managing febrile illnesses among frontline health workers (FHWs). It addresses the global health workforce shortage, especially in low- and middle-income countries, where diagnosing fevers can be challenging due to limited skilled personnel and resources. Task-shifting to frontline health workers is increasingly common, making accurate diagnostic tools crucial. This pilot study assesses implementation outcomes including feasibility, acceptability, and appropriateness of the Febra App among FHWs in Nigeria. Methods A 3-month single-arm pilot study was conducted in government-owned primary health centres (PHC) across four Nigerian states (Akwa Ibom, Cross River, Imo, and Rivers states). Implementation strategies included App development, FHW training, provision of tablets and power banks, utilization of the App by FHWs, and continuous technical assistance. Mixed methods, including a quantitative survey and qualitative interviews, were employed to evaluate the intervention. Data analysis utilized descriptive statistics for quantitative data and thematic coding and analysis for qualitative data. Results FHWs demonstrated high acceptability to using the Febra App for diagnosis of febrile illnesses, with the majority expressing approval of its ease of use, appropriateness, and relevance to their clinical practice. FHWs also found it to be feasible for routine use in PHCs, however, technical challenges, such as application crashes and poor network connectivity, posed challenges to the routine integration of the App into workflow processes. Conclusion The pilot study highlights the potential of the Febra App to enhance diagnostic accuracy and simplify the management of febrile illnesses in resource-limited settings. Recommendations for improvement included streamlining the App's usability and addressing technical issues. Addressing these implementation challenges will be critical for ensuring the sustainable adoption and scalability of the intervention.