Overcoming Cognitive and Contextual Challenges in Febrile Illness Diagnosis: Design Implications for Clinical Decision Support Systems in Sub-Saharan Africa

Abstract

Febrile illness contributes significantly to mortality and socioeco nomic burden in Sub-Saharan Africa. Clinical decision-making is complex due to overlapping symptoms, limited lab infrastructure, resource constraints, and the cognitive demands placed on health care professionals. Despite growing deployment of clinical decision support systems (CDSS) and point-of-care diagnostics, adoption and sustained use remain limited, as many tools prioritize tests or guideline enforcement while overlooking diagnostic reasoning and contextual realities. We report findings from semi-structured interviews with 26 healthcare professionals in Ghana examining cognitive and contextual challenges in febrile illness diagnosis. Us ing reflexive thematic analysis, we identify interacting cognitive challenges (e.g., reasoning under uncertainty, heuristic decision making, premature closure) and contextual constraints (test avail ability, patient costs, communication barriers, fragmented docu mentation) that shape diagnostic trajectories. We show how these challenges accumulate across diagnostic stages and reinforce em pirical treatment. We outline implications for designing workflow aligned CDSS that support diagnostic reasoning under real-world constraints in low-resource settings.