Digital innovations and health information systems: Lessons learned from implementing ALMANACH in Nigeria

Andrea Bernasconi, Daniel Ishaya, Ibrahim Sahabo, Muazu Muazu and Marianne van der Sande

PLOS Digital Health, 2026, vol. 5, issue 6, 1-18

Abstract: In low- and middle-income settings, routine health information systems (RHIS) and digital health projects often coexist, but their epidemiological outputs are rarely compared—even though integrating digital tools could strengthen RHIS by reducing reporting challenges. We conducted a retrospective, facility-level analysis of quarterly data (2017–2021) from Adamawa State, Nigeria, comparing ALMANACH, a clinical decision support system used in primary health care, with the state RHIS for malaria, pneumonia, gastrointestinal disorders, and measles in children under five years of age. The primary outcome was the facility-aggregated quarterly absolute relative difference (ARD) between the two reporting systems; temporal trends and facility-level heterogeneity were also assessed. Paired non-parametric tests, effect sizes with 95% confidence intervals (95% CI), and linear mixed-effects models accounted for clustering and repeated measurements. Across the study period, ALMANACH reported fewer cases than RHIS for malaria (116,018 vs 233,548; ARD 80.6%, 95% CI: 64.4–89.6, p

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pdig00:0001362

DOI: 10.1371/journal.pdig.0001362

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