Study procedures
Children seeking care at included health facilities were screened for eligibility by a research assistant between 08:00 and 16:00 on weekdays. If eligible, demographic information was collected and entered in the eCRF (ePOCT+ for intervention health facilities and eCRFs for usual care facilities within the data collection system medAL-reader). Health-care providers in the control health facilities managed the patients as usual, but documented the main complaints, anthropometrics and test results (if performed), diagnoses, treatments and referral decision in the eCRF. To harmonize data collection across the intervention and control facilities, the eCRF for the control facilities was also programmed into the medAL-reader platform, but no decision support was provided. Research questions were included in the eCRF to capture whether an oral or systemic antibiotic was prescribed, and whether the patient was referred for inpatient hospitalization or other outpatient investigations. In intervention health facilities, in addition to the same information collected in the eCRF, symptoms and signs of the patients were recorded in the ePOCT+ CDSA during the consultation with the patient. The symptoms and signs entered are used by the ePOCT+ CDSA to guide the clinical consultation. Health-care providers who documented the final treatment for a consultation in ePOCT+ or the eCRF were categorized as having been managed per protocol, as recording of the final treatment is required to complete the ePOCT+ CDSA.All patients were called or visited at their home by research assistants to assess clinical outcomes and their care and treatment seeking behavior at day 7 (range 6–14 days). Research assistants performing the phone calls were blinded to the intervention status and were not part of the team enrolling patients at health facilities. Home visits rather than phone calls were conducted if the caregiver of patients did not have a phone number or did not know somebody with a phone near their home, or if research assistants were not able to reach the provided phone number after five attempts. The home visits were performed by the research assistants enrolling patients from the same health facility, and as such they were not blinded to intervention allocation. Patients who were still sick at follow-up were encouraged to return to a health facility for follow-up care. Day 7 data were recorded using REDCap web for phone calls and REDCap mobile application for home visits.