Implementation of Smart Triage combined with a quality improvement program for children presenting to facilities in Kenya and Uganda: An interrupted time series analysis.

Summary

In Kenya, Smart Triage reduced time to IV antibiotics by 98 minutes (57%) compared to baseline and opposite trends at control sites, while Uganda saw non-sustained effects. Both settings showed substantial reductions in antimicrobial utilization and admissions; mortality decreases were observed but were secondary outcomes and warrant cautious interpretation.

Key Findings

• Kenya intervention sites achieved a 98-minute (57%, 95% CI 81–114) reduction in time to IV antibiotics during implementation, while control sites increased by 49 minutes.
• Antimicrobial utilization decreased by 47% (Kenya) and 33% (Uganda) at intervention sites versus baseline.
• Admission rates decreased by 47% (Kenya) and 33% (Uganda), with mortality reductions of 25% and 75% respectively (secondary outcomes).

Clinical Implications

Adopting digital triage with integrated QI can shorten delays to IV antibiotics and reduce unnecessary antimicrobial exposure; context-specific barriers (e.g., staffing, COVID-19 disruptions) must be addressed to sustain gains.

Limitations

• Heterogeneous effects and non-sustained improvements in Uganda; potential confounding from COVID-19 and resource constraints
• Mortality and admission outcomes were secondary and not powered as primary endpoints

Future Directions

Hybrid effectiveness-implementation trials to optimize fidelity, sustainability, and equity; integration with antimicrobial stewardship and diagnostics to refine triage thresholds.