Improving Health of Children in Nigeria


To improve diagnosis and treatment of children under five, Swiss TPH together with the International Committee of the Red Cross (ICRC) developed the electronic decision support tool ALMANACH. After successful pilots in Nigeria and Afghanistan, another important milestone has now been reached: A survey in the Adamawa state in Nigeria indicates that most primary care facilities have the prerequisites in place and are ready for ALMANACH scale up.

The tablet-based decision support tool supports health workers in diagnosing and treating sick children.

Every year, 5.6 million children under the age of five years die worldwide. About two thirds of these deaths could be prevented with relatively simple and affordable interventions. One of these is the Integrated Management of Childhood Illness (IMCI) scheme, a cornerstone intervention of the World Health Organization (WHO) in reducing child mortality. IMCI is a symptom-based assessment that enables high quality diagnosis and treatment of sick children.

Tablet-based tool to facilitate diagnosis and treatment

For many health workers, however, using paper-based IMCI charts during consultation is challenging and results in limited application of IMCI. To improve the utilization of IMCI in the daily practice of health facilities, the Swiss Tropical and Public Health Institute (Swiss TPH), together with the International Committee of the Red Cross (ICRC), developed ALMANACH; a tablet-based clinical decision support tool that is based on Algorithms for the Management of Childhood Illnesses.

Improving health of children in a conflict-torn area

“ALMANACH simplified very much the diagnosis and leads me step by step during the assessment,” said Christy Lazarus, midwife in the Adamawa state in Nigeria. “The tool has also increased my knowledge and gives me more self-confidence as health worker.”After successful pilot phases in Nigeria and Afghanistan, ICRC and Swiss TPH are currently preparing a scale up in the Adamawa state. Adamawa has almost 4 million inhabitants and was strongly affected by militant attacks with thousands of internally displaced people fleeing violence from Boko Haram and other extremist activities.

“Health facilities are ready for scale up”

An important first milestone in preparation for the scale up has now been achieved: A state-wide survey revealed that in about 80% of health facilities in Adamawa, the prerequisites to introduce ALMANACH are in place. “In order to roll-out ALMANACH, health facilities need access to essential medicines, sufficient personnel, running water and availability of essential medical equipment,” said Martin Raab, Swiss TPH. “We are very happy to see that in most facilities these requirements are in place.” The scale up is planned to take place from 2018 to 2021 and will include over 300 health facilities.


ALMANACH aims to facilitate the accurate diagnosis and treatment of sick children. Country specific information on changes in treatment guidelines can be updated in ALAMANCH using information from evidence-based research. This is particularly valuable for health workers working in remote and in low resources settings. The tool provides real-time diagnostic and therapeutic support to health workers and allows for the collection and analysis of health facility data at management level. ALMANACH also enables the transmission of clinical data in a summarized form in the event of an outbreak investigation and hence improve clinical services planning.

Swiss TPH: A centre of expertise in eHealth

Swiss TPH designs and implements various initiatives related to eHealth ranging from designing devices and tools, programming software, implementing projects and building capacity, to evaluating effectiveness and developing eHealth strategies and policies. Recognising its expertise, Swiss TPH was nominated a WHO Collaborating Centre for Health Technology Management and eHealth.

ALMANACH will also be discussed during the upcoming Swiss TPH symposium on the topic of “Clinical Decision Support and Health Information Systems – Potential and Pitfalls of New Technologies”. The symposium takes place on 25 April in Basel, Switzerland.