In busy rural clinics in Rwanda, nurses often see as many as 60 patients a day. With little time for detailed assessment and patients traveling long distances, clinicians frequently prescribe medications — especially antibiotics — as a precaution. That defensive practice has driven very high antibiotic use: in a study of 32 clinics, researchers found antibiotics were given in 71% of pediatric visits.
To reduce unnecessary prescriptions and slow antimicrobial resistance, researchers developed ePOCT+, a tablet-based clinical decision algorithm that guides nurses through a structured assessment and suggests treatments. The tool translates existing guidelines into an easy step-by-step workflow, incorporates simple point-of-care tests (for example, oxygen saturation and hemoglobin), and classifies cases such as suspected pneumonia into categories like viral, bacterial or simple illness. Antibiotics are recommended only for cases judged bacterial. A typical ePOCT+ consultation takes about 10 minutes, and clinicians needed only one day of practice to learn the system.
The team tracked nearly 60,000 visits across the participating clinics. After introducing ePOCT+, the proportion of pediatric visits ending with an antibiotic prescription dropped from 71% to 25% — a large reduction that did not result in worse health outcomes, according to the investigators. Although 25% is likely higher than the theoretical minimum (researchers estimate an ideal rate might be 10–15% under optimal conditions), the change represents a major step toward more targeted antibiotic use.
Clinician adherence to the algorithm was not perfect, and some nurses continued to prescribe outside the tool’s recommendations. Still, ePOCT+ also helped identify conditions that had been missed previously, such as malnutrition and anemia. Patients and staff responded positively: caregivers reported feeling more thoroughly examined, and nurses appreciated the additional guidance even though consultations took longer.
The Rwandan government has taken interest in the approach. Officials working on a national electronic medical record system have discussed integrating elements of ePOCT+, and the Rwanda Social Security Board sees potential cost savings from fewer unnecessary prescriptions.
Scaling the system will require overcoming challenges: training thousands of health workers, sustaining consistent use, maintaining software and devices, and confirming similar benefits outside the study sites. Still, researchers view the approach as a promising, scalable way to improve care quality and help curb the rise of antimicrobial resistance by ensuring antibiotics are used more appropriately.