Implementation of a Novel Mobile Health Tool for Diarrhea Management in Low-Resource Settings

Our recently developed AI-based models for assessing dehydration severity in children under five years (DHAKA models) and patients over age five (NIRUDAK models) are more accurate and reliable than the WHO algorithms, which are the current standard treatment guidelines in most settings worldwide. We incorporated these models into a novel mobile health (mHealth) clinical decision support tool called “FluidCalc” that has the potential to improve diarrhea management for acute and emergency care providers worldwide. We conducted this study to evaluate the barriers and facilitators to uptake and usage of our mHealth app in Tanzania among clinicians and stakeholders.

Between February and July 2025, qualitative data were collected through five focus group discussions with five categories of providers, and six in-depth interviews with stakeholders from four health facilities in Dar es Salaam. The Consolidated Framework for Implementation Research (CFIR) was used to guide the discussions and elicit feedback from participants. Audio recordings were transcribed and translated from Swahili to English; data were analyzed using a framework matrix analysis.

Facilitators to implementation of the app included its simplicity and ease of use. Participants noted the app's potential to simplify and speed up clinicians’ work, ensure adherence to diarrhea management practice guidelines, and reduce errors in calculation of fluid rehydration. Potential challenges included the need for mobile devices, reliable internet connectivity , and software updates. The app could be especially useful for speeding up fluid calculations and improving efficiency in outbreak situations with very high patient volumes, however there was some concern that lack of electricity or infrastructure could impede use. Participants wanted dedicated training of end-users to ensure user confidence and uptake of the FluidCalc tool and emphasized the need for the Ministry of Health approval and endorsement.

The FluidCalc app has high potential utility for caring for patients with acute diarrhea in clinical practice. Addressing potential barriers will ensure effective integration into patient care.