Diagnostic and Treatment Algorithm

What is it?

Who uses it?

Why use it?

When to use it?

How to use it:

Observe the clinic for a chosen amount of time, until a pattern can be observed. Select the most frequent reasons for consultation. You can use a Tally Sheet and a Pareto Analysis to determine the most frequent reasons for consultation. For example, one frequent reason children come for a consultation is "fever."

2. Define possible diagnoses.

Define the most frequent or critical diseases that could cause the selected symptom. A review of the case mix in your area using the Health Information System could be useful at this point. For example, fever in children can be caused by meningitis (in endemic areas), malaria, measles, acute respiratory infections (ARI), ear infection, or the flu.

3. List associated symptoms.

List the most common or easy-to-recognize, specific symptom associated with each disease. If several symptoms could be associated with the disease, select the most specific and the most easy-to-recognize symptom.

For example, a specific symptom of meningitis is neck stiffness; of measles, eruption; a common symptom of ARI is cough; of malaria, headache; of ear infection, ear pain; and of flu, runny nose.

4. Create a flowchart.

Organize the symptoms in a flowchart so you can diagnose the diseases by process of elimination, one by one. Start with the most specific symptom (only present in the case of that disease) and proceed to the most common (associated with several possible diseases), only giving two options at each step (yes/no). The last diagnosis will be arrived at by eliminating all specific symptoms.

Sample diagnosis and treatment flowchart:

5. Define the decision to make at each step.

For each diagnosis, there are three possible decisions to be made:

1. Use another algorithm to pinpoint the diagnosis (or the treatment).

   For example: cough (plus fever) can tell you that the child is suffering from ARI but doesn't give enough information for deciding on the treatment. Therefore, you need to develop an algorithm specifically for cough.

2. Referral for complementary diagnostic tests or treatment.

   For example: neck stiffness is a life-threatening sign and requires a referral to the hospital.

3. Treatment and follow-up, which has to be specified.

   For example: a runny nose can be treated with aspirin. Malaria should be treated with aspirin and chloroquine. In both cases, the dose per weight and posology should be specified.