Clinical decision support algorithm to optimize management of respiratory tract infection in children attending primary health facilities in Kilimanjaro Region, Tanzania - Respiratory tract infections (RTIs) remain a leading cause of preventable deaths among children under five years in low- and middle-income countries (LMICs). Although severe RTIs require prompt antibacterial treatment, most pediatric RTIs are viral and self-limiting. Nonetheless, studies in LMICs indicate that over 75% of outpatient pediatric RTI visits result in antibiotic prescriptions, felling antimicrobial resistance (AMR), a growing global health threat with direct implications for the U.S. For these exceedingly common, non-severe viral RTI cases, antibacterials are not appropriate and could cause harm. RTI management is thus highly problematic: on the one hand, a common syndrome that is grossly over-treated with inappropriate antibacterials; on the other hand, clinicians in low-resourced LMIC settings can understandably be concerned that withholding antibacterials could run the risk of a pediatric RTI progressing to a severe, life-threatening condition. This research will take place in Kilimanjaro Region Tanzania, where a high RTI burden, limited diagnostic capacity, and widespread antibiotic overuse create a critical environment to develop and test context-appropriate clinical decision tools. These conditions are not easily replicated in the United States, offering a unique opportunity to generate generalizable knowledge for LMICs. The project has three aims: (1) Develop and validate a clinical prediction rule integrating clinical features and novel biomarkers to distinguish viral from bacterial RTIs and assess disease severity in children at health facilities; (2) Conduct qualitative research to understand caregiver and provider expectations, attitudes, and thresholds for withholding antibiotics in uncomplicated RTIs; and (3) Apply human-centered design to create a user-friendly clinical decision support tool for frontline healthcare providers. The candidate for this career development award is a Tanzanian medical doctor with advanced training in clinical research, public health, and epidemiology. He has conducted clinical research on RTI in Tanzania since 2016. Aligned with Fogarty International Center priorities, this K43 award will provide mentored research training to a Tanzanian physician-scientist in clinical prediction modeling, implementation science, and human-centered intervention design. Supported by a multidisciplinary team of U.S. and Tanzanian mentors, the project will strengthen institutional partnerships and local research capacity. This work advances the NIH mission by generating knowledge to improve RTI management, reduce inappropriate antibiotic use, and mitigate AMR. Findings will inform scalable, evidence-based strategies for resource-limited settings globally and underserved U.S. populations, where diagnostic uncertainty and antibiotic overuse remain challenges. Upon completion, the candidate will be positioned as an independent investigator advancing infectious disease management and antibiotic stewardship in LMICs and beyond.
