Digital decision support tool shows promise for child respiratory care in Uganda

The tool, known as ALRITE, was deployed at two outpatient health centers over three months, and researchers paired usage data with focus group discussions to understand what helped and what hindered its adoption.

Acute lower respiratory illnesses are the leading cause of mortality in young children, and the greatest burden falls on sub-Saharan Africa. The ALRITE tool was developed to aid healthcare workers in diagnosing and managing these illnesses in children, with a particular focus on wheezing illness and asthma, conditions that the study found are often overlooked in routine care.

The implementation study enrolled all eligible healthcare workers at the two sites, a total of seven clinical officers with a median age of 39 years, six of whom were male. Twenty-three caregivers of children also took part, with a median age of 36 years; nineteen of them, or 83 percent, were female. The research team tracked how often the tool was used, how long each encounter lasted, and the clinical data recorded during consultations.

Over the study period, there were 1,129 clinical consultations among children aged 2 to 59 months presenting with acute respiratory complaints. Upper respiratory infections accounted for 50 percent of diagnoses and pneumonia for 47 percent, making them by far the most common findings. Asthma was rarely diagnosed, appearing in just 0.35 percent of consultations, a striking figure that underscores how infrequently wheezing illness is recognized in this setting.

ALRITE was used in 159 of the 1,129 consultations, or 14 percent of encounters. The median duration of an ALRITE-supported encounter was four minutes, with an interquartile range of three to seven minutes, suggesting that the tool could be completed within a timeframe compatible with busy outpatient clinics.

The qualitative component of the study relied on one focus group discussion with healthcare workers and two with caregivers. The researchers analyzed the transcripts using content analysis, aggregating codes into major themes and subthemes, and then organized them post hoc using the Consolidated Framework for Implementation Research.

Four major themes emerged. First, healthcare workers described ALRITE as accurate and well-organized, and said it improved their confidence and their care for children with wheezing illnesses, though they called for optimization in efficiency, flexibility, and comprehensive care. Second, successful implementation was seen to require improving communication between healthcare workers and caregivers. Third, equipment shortages, insecure technology infrastructure, and limited staffing were identified as significant barriers, both to pediatric respiratory care generally and to implementing new technologies. Fourth, the participants suggested that engaging caregivers early in implementation, improving healthcare worker training, and incorporating performance reviews and incentives may enhance adoption.

The study’s authors conclude that ALRITE remains a promising tool to improve the management of acute lower respiratory illnesses and to increase awareness of wheezing among healthcare workers, but that realizing this promise will require improved design, community engagement, and integration into routine clinical care. As a prospective implementation study conducted at only two health centers over three months, with a small number of participating clinicians and caregivers, the findings describe early implementation experience rather than evidence of the tool’s effect on patient outcomes, and the low overall usage rate of 14 percent of consultations highlights the gap between a promising intervention and routine adoption in resource-constrained settings.

Subject of Research: Implementation of a digital clinical decision support tool for pediatric respiratory illnesses in Ugandan outpatient facilities

Article Title: Implementation of a digital clinical decision support tool for pediatric respiratory illnesses in 2 outpatient facilities in Uganda and qualitative analysis of challenges and opportunities

Article References: Lu, N., Nantanda, R., Namusoko, S., Najjingo, I., Ekyaruhanga, P., Farquhar, S. A., Edelson, J., Stout, J. W., Mutebi, C., Nakatumba-Nabende, J., Rosenfeld, M., Weiner, B. J., & Ellington, L. E. (2026). Implementation of a digital clinical decision support tool for pediatric respiratory illnesses in 2 outpatient facilities in Uganda and qualitative analysis of challenges and opportunities. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15877-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15877-1

Keywords: clinical decision support, pediatric respiratory illness, Uganda, ALRITE, implementation science, asthma, pneumonia, digital health, healthcare workers, focus groups, CFIR, low-resource settings