A mobile phone based tool to identify symptoms of common childhood diseases in Ghana: Development and evaluation of the integrated clinical algorithm in a cross-sectional study

Background: The aim of this study was the development and evaluation of an algorithm-based diagnosis-tool, applicable on mobile phones, to support guardians in providing appropriate care to sick children. Methods: The algorithm was developed on the basis of the Integrated Management of Childhood Illness (IMCI) guidelines and evaluated at a hospital in Ghana. Two hundred and thirty-seven guardians applied the tool to assess their child's symptoms. Data recorded by the tool and health records completed by a physician were compared in terms of symptom detection, disease assessment and treatment recommendation. To compare both assessments, Kappa statistics and predictive values were calculated. Results: The tool detected the symptoms of cough, fever, diarrhoea and vomiting with good agreement to the physicians' findings (kappa = 0.64; 0.59; 0.57 and 0.42 respectively). The disease assessment barely coincided with the physicians' findings. The tool's treatment recommendation correlated with the physicians' assessments in 93 out of 237 cases (39.2% agreement, kappa = 0.11), but underestimated a child's condition in only seven cases (3.0%). Conclusions: The algorithm-based tool achieved reliable symptom detection and treatment recommendations were administered conformably to the physicians' assessment. Testing in domestic environment is envisaged.