NIGERIA— ALMANACH, a mobile application based on the Integrated Management on Childhood Illnesses (IMCI) strategy of the United Nations Children’s Fund (UNICEF), is transforming clinical decision-making in Adamawa, Nigeria.

In 2016, the program was launched as a collaboration between the Adamawa State Primary Healthcare Development Agency (ADSCPHCDA), the Swiss Tropical and Public Health Institute (SWISS TPHI), and the International Red Cross Society, and was initially tested in 12 medical facilities across five local governments to enhance clinical decision-making.

The program was subsequently scaled up in 2018, and it is now being used in 413 primary healthcare centers (PHCs) across the state, which run 24-hour services.

To date, more than 682 health workers have been trained, and over 350 thousand consultations have been conducted using ALMANACH.

The application is installed on mobile devices like tablets and guides health workers through a structured consultation process to ensure that all relevant information is collected and recorded.

It prompts requests for lab tests and shows the health worker how to perform nutrition assessments and routine preventive actions like deworming and Vitamin A.

ALMANACH is designed to adapt to the local context by functioning online and offline.

In 2020, a study conducted showed that facilities, where the tool was used, reported significant improvements, and children consulted with ALMANACH recovered within seven days.

Furthermore, the indiscriminate use of antibiotics was reduced, and the state’s antibiotic prescription rate decreased from 78% in 2018 to between 19% and 21% currently.

In 2021, ALMANACH was handed over to ADSPHCDA, and it was included in the agency’s annual operational plan to sustain the project’s results.

Dr. Paul Margwa, Director of Planning Research and Statistics at ADSCPHCDA, described ALMANACH as a digital form of an improved version of IMCI developed to improve case management in primary healthcare settings.

Moreover, the project’s success was presented at the 63rd National Council on Health in December 2022, and five states (Gombe, Kano, Kaduna, Yobe, and Taraba) expressed interest in scaling up the project.

Since the launch of UNICEF’s IMCI strategy in 1994, it has been adopted in Nigeria, where significant changes have been made to the healthcare system.

However, challenges persist, and Nigeria’s under-5 years mortality remains high, with more than half of under-5 deaths globally occurring in five countries, including Nigeria.

Poverty and a lack of access to essential healthcare services contribute to under-5 mortality in Adamawa, while the insurgency in the region has disrupted health services and displaced communities, making it difficult for children to access healthcare services.

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