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Kumar H, Sarin E, Saboth P, Jaiswal A, Chaudhary N, Mohanty JS, Bisht N, Tomar SS, Gupta A, Panda R, Patel R, Kumar A, Gupta S, Alwadhi V. Experiences From an Implementation Model of ARI Diagnostic Device in Pneumonia Case Management Among Under-5 Children in Peripheral Healthcare Centers in India. Clin Med Insights Pediatr 2021; 15:11795565211056649. [PMID: 34803419 PMCID: PMC8600550 DOI: 10.1177/11795565211056649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/10/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To address pneumonia, a major killer of under-5 children in India, a multimodal pulse oximeter was implemented in Health and Wellness Centers. Given the evidence of pulse oximetry in effective pneumonia management and taking into account the inadequate skills of front-line healthcare workers in case management, the device was introduced to help them readily diagnose and treat a child and to examine usability of the device. DESIGN The implementation was integrated with the routine OPD of primary health centers for 15 months after healthcare workers were provided with an abridged IMNCI training. Monthly facility data was collected to examine case management with the diagnostic device. Feedback on usefulness of the device was obtained. SETTING Health and Wellness Centers (19) of 7 states were selected in consultation with state National Health Mission based on patient footfall. PARTICIPANTS Under-5 children presenting with ARI symptoms at the OPD. RESULTS Of 4846 children, 0.1% were diagnosed with severe pneumonia and 23% were diagnosed with pneumonia. As per device readings, correct referrals were made of 77.6% of cases of severe pneumonia, and 81% of pneumonia cases were correctly given antibiotics. The Pulse oximeter was highly acceptable among health workers as it helped in timely classification and treatment of pneumonia. It had no maintenance issue and battery was long-lasting. CONCLUSION Pulse oximeter implementation was doable and acceptable among health workers. Together with IMNCI training, PO in primary care settings is a feasible approach to provide equitable care to under-5 children.
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O’Loughlin F, Phangmanixay S, Sisouk K, Phommanivong V, Phiahouaphanh O, AlEryani S, Raajimakers H, Gray A. Integrated Management of Neonatal and Childhood Illness Training in Lao PDR: A Pilot Study of an Adaptable Approach to Training and Supervision. Am J Trop Med Hyg 2021; 105:1618-1623. [PMID: 34491216 PMCID: PMC8641326 DOI: 10.4269/ajtmh.21-0544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/06/2021] [Indexed: 11/07/2022] Open
Abstract
Integrated Management of Neonatal and Childhood Illness (IMNCI) has been part of the national strategy for child health in Lao Peoples Democratic Republic since 2003. The program, while running for an extended period, has faced multiple challenges including maintaining the teaching quality for the implementation of the IMNCI guidelines and a structure to enable and support healthcare workers trained to apply the training in their workplace. A revised training model that focused on building skills for teaching according to adult learning principles in a pool of facilitators, a practical and hands-on training workshop for healthcare workers, and the establishment of a program of health center supervision was developed and implemented in three provinces. Participants in the revised model reported increased confidence in implementing IMNCI guidelines, they demonstrated competence in the steps of IMNCI and on follow-up assessment at a supervision visit were found to have improved patient care through the measurement of pediatric case management scores. This study highlights the importance of a focus on education to ensure the translation of guidelines into practice and thereby lead to improvements in the quality of pediatric care. The IMNCI training approach is acceptable and valued by healthcare worker participants.
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Affiliation(s)
- Freya O’Loughlin
- Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | | | - Kongkham Sisouk
- Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | | | | | - Salwa AlEryani
- Health and Nutrition Section, UNICEF, Vientiane, Lao PDR
| | | | - Amy Gray
- Centre for International Child Health, University of Melbourne, Melbourne, Australia
- The Royal Children’s Hospital, Melbourne, Australia
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Kilov K, Hildenwall H, Dube A, Zadutsa B, Banda L, Langton J, Desmond N, Lufesi N, Makwenda C, King C. Integrated Management of Childhood Illnesses (IMCI): a mixed-methods study on implementation, knowledge and resource availability in Malawi. BMJ Paediatr Open 2021; 5:e001044. [PMID: 34013071 PMCID: PMC8098945 DOI: 10.1136/bmjpo-2021-001044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The introduction of the WHO's Integrated Management of Childhood Illnesses (IMCI) guidelines in the mid-1990s contributed to global reductions in under-five mortality. However, issues in quality of care have been reported. We aimed to determine resource availability and healthcare worker knowledge of IMCI guidelines in two districts in Malawi. METHODS We conducted a mixed-methods study, including health facility audits to record availability and functionality of essential IMCI equipment and availability of IMCI drugs, healthcare provider survey and focus group discussions (FGDs) with facility staff. The study was conducted between January and April 2019 in Mchinji (central region) and Zomba (southern region) districts. Quantitative data were described using proportions and χ2 tests; linear regression was conducted to explore factors associated with IMCI knowledge. Qualitative data were analysed using a pragmatic framework approach. Qualitative and quantitative data were analysed and presented separately. RESULTS Forty-seven health facilities and 531 healthcare workers were included. Lumefantrine-Artemether and cotrimoxazole were the most available drugs (98% and 96%); while amoxicillin tablets and salbutamol nebuliser solution were the least available (28% and 36%). Respiratory rate timers were the least available piece of equipment, with only 8 (17%) facilities having a functional device. The mean IMCI knowledge score was 3.96 out of 10, and there was a statistically significant association between knowledge and having received refresher training (coeff: 0.42; 95% CI 0.01 to 0.82). Four themes were identified in the FGDs: IMCI implementation and practice, barriers to IMCI, benefits of IMCI and sustainability. CONCLUSION We found key gaps in IMCI implementation; however, these were not homogenous across facilities, suggesting opportunities to learn from locally adapted IMCI best practices. Improving on-going mentorship, training and supervision should be explored to improve quality of care, and programming which moves away from vertical financing with short-term support, to a more holistic approach with embedded sustainability may address the balance of resources for different conditions.
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Affiliation(s)
- Kim Kilov
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Helena Hildenwall
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | | | - Lumbani Banda
- Parent and Child Health Initiative, Lilongwe, Malawi
| | - Josephine Langton
- Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi
| | - Nicola Desmond
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Norman Lufesi
- Acute Respiratory Infections Unit, Ministry of Health, Lilongwe, Malawi
| | | | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Institute for Global Health, University College London, London, UK
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Muhandule Birindwa A, Gonzales-Siles L, Nordén R, Geravandi S, Tumusifu Manegabe J, Morisho L, Saili Mushobekwa S, Andersson R, Skovbjerg S. High bacterial and viral load in the upper respiratory tract of children in the Democratic Republic of the Congo. PLoS One 2020; 15:e0240922. [PMID: 33119683 PMCID: PMC7595347 DOI: 10.1371/journal.pone.0240922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Respiratory pathogens including Streptococcus pneumoniae and Haemophilus influenzae, are implicated in the pathogenicity of acute lower respiratory infection (ALRI). These are also commonly found in both healthy and sick children. In this study, we describe the first data on the most frequent bacteria and viruses detected in the nasopharynx of children from the general population in the Eastern DR Congo. METHODS From January 2014 to June 2015, nasopharyngeal samples from 375 children aged from 2 to 60 months attending health centres for immunisation or growth monitoring were included in the study. Multiplex real-time PCR assays were used for detection of 15 different viruses and 5 bacterial species and for determination of pneumococcal serotypes/serogroups in the nasopharyngeal secretions. RESULTS High levels of S. pneumoniae were detected in 77% of cases, and H. influenzae in 51%. Rhinovirus and enterovirus were the most commonly found viruses, while respiratory syncytial virus (RSV) was rare (1%). Co-occurrence of both bacteria and viruses at high levels was detected in 33% of the children. The pneumococcal load was higher in those children who lived in a dwelling with an indoor kitchen area with an open fire, i.e. a kitchen with an open fire for cooking located inside the dwelling with the resultant smoke passing to the living room and/or bedrooms; this was also higher in children from rural areas as compared to children from urban areas or children not living in a dwelling with an indoor kitchen area with an open fire/not living in this type of dwelling. Immunization with 2-3 doses of PCV13 was associated with lower rates of pneumococcal detection. Half of the identified serotypes were non-PCV13 serotypes. The most common non-PCV13 serotypes/serogroups were 15BC, 10A, and 12F, while 5, 6, and 19F were the most prevalent PCV13 serotypes/serogroups. CONCLUSIONS The burden of respiratory pathogens including S. pneumoniae in Congolese children was high but relatively few children had RSV. Non-PCV13 serotypes/serogroups became predominant soon after PCV13 was introduced in DR Congo.
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Affiliation(s)
- Archippe Muhandule Birindwa
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
- Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
- Institut Superieur Technique Medical, Uvira, Democratic Republic of the Congo
- * E-mail: ,
| | - Lucia Gonzales-Siles
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Nordén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Shadi Geravandi
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Susann Skovbjerg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
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García Sierra AM, Ocampo Cañas JA. Integrated Management of Childhood Illnesses implementation-related factors at 18 Colombian cities. BMC Public Health 2020; 20:1122. [PMID: 32677944 PMCID: PMC7364581 DOI: 10.1186/s12889-020-09216-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated Management of Childhood Illnesses (IMCI) is a strategy developed by the World Health Organization (WHO) and UNICEF in 1992. It was deployed as an integrated approach to improve children's health in the world. This strategy is divided into three components: organizational, clinical, and communitarian. If the Integrated Management of Childhood Illnesses implementation-related factors in low- and middle-income countries are known, the likelihood of decreasing infant morbidity and mortality rates could be increased. This work aimed to identify, from the clinical component of the strategy, the implementation-related factors to Integrated Management of Childhood Illnesses at 18 Colombian cities. METHODS A quantitative cross-sectional study was performed with a secondary analysis of databases of a study conducted in Colombia by the Public Health group of Universidad de Los Andes in 2016. An Integrated Care Index was calculated as a dependent variable and descriptive bivariate and multivariate analyses to find the relationship between this index and the relevant variables from literature. RESULTS Information was obtained from 165 medical appointments made by nurses, general practitioners, and pediatricians. Health access is given mainly in the urban area, in the first level care and outpatient context. Essential medicines availability, necessary supplies, second-level care, medical appointment periods longer than 30 min, and care to the child under 30 months are often related to higher rates of Integrated Care Index. CONCLUSION Health care provided to children under five remains incomplete because it does not present the basic minimums for the adequate IMCI's implementation in the country. It is necessary to provide integrated care that provides medicine availability and essential supplies that reduce access barriers and improve the system's fragmentation.
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Picken S, Hannington J, Fairall L, Doherty T, Bateman E, Richards M, Wattrus C, Cornick R. PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents. BMJ Glob Health 2018; 3:e000957. [PMID: 30397519 PMCID: PMC6203049 DOI: 10.1136/bmjgh-2018-000957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 02/03/2023] Open
Abstract
Pioneering strategies like WHO's Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults, that expands the scope and reach of integrated management and training programmes for paediatric primary care. This paper describes the development and key features of the PACK Child clinical decision support tool for the care of children up to 13 years, and lessons learnt during its development.
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Affiliation(s)
- Sandy Picken
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Juliet Hannington
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Mowbray, South Africa
| | - Tanya Doherty
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Mark Richards
- Department of Paediatrics and Child Health, Somerset Hospital, University of Cape Town, Green Point, South Africa
| | - Camilla Wattrus
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Mowbray, South Africa
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Rowe AK, Labadie G, Jackson D, Vivas-Torrealba C, Simon J. Improving health worker performance: an ongoing challenge for meeting the sustainable development goals. BMJ 2018; 362:k2813. [PMID: 30061366 PMCID: PMC6283359 DOI: 10.1136/bmj.k2813] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Guilhem Labadie
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Debra Jackson
- Health Section, Programme Division, United Nations Children's Fund, New York, USA
| | | | - Jonathon Simon
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland
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Boschi-Pinto C, Labadie G, Dilip TR, Oliphant N, Dalglish SL, Aboubaker S, Agbodjan-Prince OA, Desta T, Habimana P, Butron-Riveros B, Al-Raiby J, Siddeeg K, Kuttumuratova A, Weber M, Mehta R, Raina N, Daelmans B, Diaz T. Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on. BMJ Open 2018; 8:e019079. [PMID: 30061428 PMCID: PMC6067364 DOI: 10.1136/bmjopen-2017-019079] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/28/2017] [Accepted: 05/01/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To assess the extent to which Integrated Management of Childhood Illness (IMCI) has been adopted and scaled up in countries. SETTING The 95 countries that participated in the survey are home to 82% of the global under-five population and account for 95% of the 5.9 million deaths that occurred among children less than 5 years of age in 2015; 93 of them are low-income and middle-income countries (LMICs). METHODS We conducted a cross-sectional self-administered survey. Questionnaires and data analysis focused on (1) giving a general overview of current organisation and financing of IMCI at country level, (2) describing implementation of IMCI's three original components and (3) reporting on innovations, barriers and opportunities for expanding access to care for children. A single data file was created using all information collected. Analysis was performed using STATA V.11. PARTICIPANTS In-country teams consisting of representatives of the ministry of health and country offices of WHO and Unicef. RESULTS Eighty-one per cent of countries reported that IMCI implementation encompassed all three components. Almost half (46%; 44 countries) reported implementation in 90% or more districts as well as all three components in place (full implementation). These full-implementer countries were 3.6 (95% CI 1.5 to 8.9) times more likely to achieve Millennium Development Goal 4 than other (not full implementer) countries. Despite these high reported implementation rates, the strategy is not reaching the children who need it most, as implementation is lowest in high mortality countries (39%; 7/18). CONCLUSION This survey provides a unique opportunity to better understand how implementation of IMCI has evolved in the 20 years since its inception. Results can be used to assist in formulating strategies, policies and activities to support improvements in the health and survival of children and to help achieve the health-related, post-2015 Sustainable Development Goals.
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Affiliation(s)
- Cynthia Boschi-Pinto
- Department of Maternal Newborn Child and Adolescent Heath, World Health Organization, Geneva, Switzerland
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niteroi, Brazil
| | - Guilhem Labadie
- Department of Maternal Newborn Child and Adolescent Heath, World Health Organization, Geneva, Switzerland
| | | | - Nicholas Oliphant
- The Global Fund to Fight AIDS, Geneva, Switzerland
- UNICEF, New York, USA
| | - Sarah L Dalglish
- Department of Maternal Newborn Child and Adolescent Heath, World Health Organization, Geneva, Switzerland
| | - Samira Aboubaker
- Department of Maternal Newborn Child and Adolescent Heath, World Health Organization, Geneva, Switzerland
| | | | - Teshome Desta
- World Health Organization, Regional Office for East and Southern Africa, Harare, Zimbabwe
| | - Phanuel Habimana
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Jamela Al-Raiby
- World Health Organization, Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Khalid Siddeeg
- World Health Organization, Regional Office for Eastern Mediterranean, Cairo, Egypt
| | | | - Martin Weber
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Rajesh Mehta
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Neena Raina
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Bernadette Daelmans
- Department of Maternal Newborn Child and Adolescent Heath, World Health Organization, Geneva, Switzerland
| | - Theresa Diaz
- Department of Maternal Newborn Child and Adolescent Heath, World Health Organization, Geneva, Switzerland
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Muhe LM, Iriya N, Bundala F, Azayo M, Bakari MJ, Hussein A, John T. Evaluation of distance learning IMCI training program: the case of Tanzania. BMC Health Serv Res 2018; 18:547. [PMID: 30001709 PMCID: PMC6044076 DOI: 10.1186/s12913-018-3336-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The standard 11-days IMCI (Integrated Management of Childhood Illness) training course (standard IMCI) has faced barriers such as high cost to scale up. Distance learning IMCI training program was developed as an alternative to the standard IMCI course. This article presents the evaluation results of the implementation of distance learning IMCI training program in Tanzania. METHODS From December 2012 to end of June 2015, a total of 4806 health care providers (HCP) were trained on distance learning IMCI from 1427 health facilities {HF) in 68 districts in Tanzania. Clinical assessments were done at the end of each course and on follow up visits of health facilities 4 to 6 weeks after training. The results of those assessments are used to compare performance of health care providers trained in distance learning IMCI with those trained in the standard IMCI course. Statistical analysis is done by comparing proportions of those with appropriate performances using four WHO priority performance indicators as well as cost of conducting the courses. In addition, the perspectives of health care providers, IMCI course facilitators, policy makers and partners were gathered using either focussed group discussions or structured questionnaires. RESULTS Distance learning IMCI allowed clusters of training courses to take place in parallel, allowing rapid expansion of IMCI coverage. Health care providers trained in distance learning IMCI performed equally well as those trained in the standard IMCI course in assessing Main Symptoms, treating sick children and counselling caretakers appropriately. They performed better in assessing Danger Signs. Distance learning IMCI gave a 70% reduction in cost of conducting the training courses. CONCLUSION Distance learning IMCI is an alternative to scaling up IMCI as it provides an effective option with significant cost reduction in conducting training courses.
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Affiliation(s)
- Lulu M Muhe
- Department of Pediatrics and Child Health, Addis Ababa University, P.O.Box 1768, Addis Ababa, Ethiopia.
| | - Nemes Iriya
- Child and Adolescent Health, World Health Organization Country Office, Dar Es Salaam, Tanzania
| | | | - Mary Azayo
- UNICEF Country Office, Dar Es Salaam, Tanzania
| | | | | | - Theopista John
- Child and Adolescent Health, World Health Organization Country Office, Dar Es Salaam, Tanzania
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Krüger C, Heinzel-Gutenbrunner M, Ali M. Adherence to the integrated management of childhood illness guidelines in Namibia, Kenya, Tanzania and Uganda: evidence from the national service provision assessment surveys. BMC Health Serv Res 2017; 17:822. [PMID: 29237494 PMCID: PMC5729502 DOI: 10.1186/s12913-017-2781-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/06/2017] [Indexed: 01/29/2023] Open
Abstract
Background Integrated Management of Childhood Illness (IMCI) is regarded as a standard public health approach to lowering child mortality in developing countries. However, little is known about how health workers adhere to the guidelines at the national level in sub-Saharan African countries. Methods Data from the Service Provision Assessment surveys of Namibia (NA) (survey year: 2009), Kenya (KE) (2010), Tanzania (TZ) (2006) and Uganda (UG) (2007) were analysed for adherence to the IMCI guidelines by health workers. Potential influencing factors included the survey country, patient’s age, the different levels of the national health system, the training level of the health care provider (physician, non-physician clinician, nurse-midwife, auxiliary staff), and the status of re-training in IMCI. Results In total, 6856 children (NA: 1495; KE: 1890; TZ: 2469; UG: 1002 / male 51.2–53.5%) aged 2–73 months (2–24 months, 65.3%; median NA: 19 months; KE: 18 months; TZ: 16 months; UG: 15 months) were clinically assessed by 2006 health workers during the surveys. Less than 33% of the workers carried out assessment of all three IMCI danger signs, namely inability to eat/drink, vomiting everything, and febrile convulsions (NA: 11%; KE: 11%; TZ: 14%; UG: 31%) while the rate for assessing all three of the IMCI main symptoms of cough/difficult breathing, diarrhoea, and fever was < 60% (NA: 48%; KE: 34%; TZ: 50%; UG: 57%). Physical examination rates for fever (temperature) (NA: 97%; KE: 87%; TZ: 73%; UG: 90%), pneumonia (respiration rate/auscultation) (NA: 43%; KE: 24%; TZ: 25%; UG: 20%) and diarrhoea (dehydration status) (NA: 29%; KE: 19%; TZ: 20%; UG: 39%) varied widely and were highest when assessing children with the actual diagnosis of pneumonia and diarrhoea. Adherence rates tended to be higher in children ≤ 24 months, at hospitals, among higher-qualified staff (physician/non-physician clinician) and among those with recent IMCI re-training. Conclusion Despite nationwide training in IMCI the adherence rates for assessment and physical examination remained low in all four countries. IMCI training should continue to be provided to all health staff, particularly nurses, midwives, and auxiliary staff, with periodic re-training and an emphasis to equally target children of all age groups.
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Affiliation(s)
- Carsten Krüger
- Department of Paediatrics, Witten/Herdecke University, Witten, Germany. .,Children's Hospital, St. Franziskus Hospital, Robert-Koch-Strasse 55, D-59227, Ahlen, Germany.
| | | | - Mohammed Ali
- Faculty of Health Sciences, School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, Australia
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Al Araimi FAF. A Hypothetical Model to Predict the Potential Impact of Government and Management Support in Implementing Integrated Management of Childhood Illness Practices. Oman Med J 2017; 32:221-226. [PMID: 28584603 PMCID: PMC5447793 DOI: 10.5001/omj.2017.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/04/2017] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES Despite broad adoption and implementation of Integrated Management of Childhood Illness (IMCI) in more than 100 countries, childhood mortality and morbidity rates continue to prevail. This calls for further investigation to identify the factors that prevent actual application of IMCI-recommended clinical practices. This study tests a hypothetical structural model to investigate potential role of government and healthcare policymakers on improving implementation and application of IMCI-recommended practices in clinical setting. METHODS The study was carried out at Sur and Ibra Nursing Institutes in Oman, in June 2016. We used six pre-tested and validated constructs for developing a hypothetical structural model. The constructs were used as underlying variables to examine the probable influence of government and policymakers on actual application of IMCI-recommended practices. Data were collected through structured questionnaires, which designed to measure healthcare professionals' perceptions. Each construct was pre-loaded with three sub-constructs. Cronbach's alpha (CA) was used to calculate the internal consistency and reliability. RESULTS Factor loadings for each item in the model were ≥ 0.700. CA values for all the studied constructs were > 0.600. The average variance extracted values for all the constructs were > 0.500. CONCLUSIONS The findings support the hypothetical structural model and highlights governments could play a significant role in ensuring that IMCI strategy is not only implemented, but also its recommended practices are applied in clinical setting.
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Sallam SA, El-Mazary AAM, Osman AM, Bahaa MA. Integrated Management of Childhood Illness (IMCI) Approach in management of Children with High Grade Fever ≥ 39°. Int J Health Sci (Qassim) 2016; 10:239-248. [PMID: 27103906 PMCID: PMC4825897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Fever is one of the most frequently encountered pediatric problems, accounting for 25% of visits to pediatric emergency room. There is no specific standardized approach to reach to a final diagnosis in children with fever as this may be difficult and individualized for each child. The integrated management of childhood illness (IMCI) approach is an approach designed to reach a classification rather than a specific diagnosis. OBJECTIVE Comparison between IMCI and Non-IMCI approaches in management of children with high grade fever≥ 39°. PATIENTS AND METHODS This is a prospective study carried out on 50 children less than five years old presented with fever ≥ 39° attended the outpatient clinic of Minia university hospital from September 2012 to May 2014. These 50 children divided into 2 groups: group I (25 children) subjected to the (IMCI) approach and group II (25 children) subjected to the traditional approach. RESULTS Most of children according to the IMCI approach (64%) were classified and diagnosed during the first day, while most of children in traditional approach were diagnosed by the fourth (34%) or fifth day (20%). Sixty percent of children treated according to IMCI approach were improved clinically compared to 12% in traditional approach. Forty percent of children treated according to traditional approach had worse outcomes compared to 16% treated according to the IMCI. CONCLUSION The IMCI approach can be applied upon children under five years old with high grade fever to reach to a classification, early diagnosis, much better outcomes and less daily cost than the traditional approach.
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Affiliation(s)
- Salem A Sallam
- Pediatric Department, Faculty of Medicine, Minia University, Egypt
| | | | - Ashraf M Osman
- Clinical-Pathology Department, Faculty of Medicine, Minia University, Egypt
| | - Mohamed A Bahaa
- Pediatric Department, Faculty of Medicine, Minia University, Egypt
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Mayhew M, Ickx P, Newbrander W, Stanekzai H, Alawi SA. Long and short Integrated Management of Childhood Illness (IMCI) training courses in Afghanistan: a cross-sectional cohort comparison of post-course knowledge and performance. Int J Health Policy Manag 2015; 4:143-52. [PMID: 25774371 DOI: 10.15171/ijhpm.2015.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/23/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In 2003 the Afghan Ministry of Public Health (MoPH) adopted the Integrated Management of Childhood Illness (IMCI) for delivering child health services in primary care facilities. Key problems were subsequently identified: high cost of training, frequent health worker turnover and poor quality of IMCI implementation by those trained - specifically in the use of job aids and protocols for assessment, classification, treatment and counselling. The high financial, human resources and opportunity costs of implementing IMCI spurred the MoPH to prioritize developing a shortened IMCI course of comparable quality to the 11-Day training. METHODS This cross-sectional evaluation compared knowledge before and after training, and health worker performance in assessment, classification and treatment of sick children in two similar cohorts, eight months post-training. RESULTS The mean increase in knowledge scores of the thirty 7-Day course trainees was 29 [95% Confidence Interval (CI): 24, 34] compared to 23 (95% CI: 18, 28) in the 31 trained in the 11-Day course. During assessment visits, mean scores in the 7-Day course trainees and the 11-Day course trainees were 93% (95% CI: 91, 95) versus 94% (95% CI: 91, 96) in assessment; 95% (95% CI: 89, 100) versus 96% (95% CI: 91, 100) in classification; 95% (95% CI: 92, 100) versus 97% (95% CI: 95, 100) in treatment; and 81% (95% CI: 76, 86) versus 80% (95% CI: 75, 85) in counselling. The 7-Day course was 36% less expensive than the 11-Day course. For each course opportunity costs, measured as numbers of children who potentially received poorer care than usual during trainee absence, were 3,160 for the 11-Day course and 2,016 for the 7-Day course. This measure was chosen because trainee absence commonly resulted in higher patient volumes per remaining provider or complete closure of a health facility with one single health worker. CONCLUSION Given similar performance and knowledge of health workers trained in both courses, potential cost savings, the possibility of training more health workers and the relative ease with which health workers in remote settings might participate in a shorter course, it seems prudent to standardize the 7-Day course in Afghanistan where child mortality rates remain unacceptably high.
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Affiliation(s)
- Maureen Mayhew
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Paul Ickx
- BASICS/Afghanistan and Centre for Health Services, Management Sciences for Health, Medford, MA, USA
| | - William Newbrander
- BASICS/Afghanistan and Centre for Health Services, Management Sciences for Health, Medford, MA, USA
| | | | - Sayed Alisha Alawi
- Child and Adolescent Health Department, Ministry of Public Health, Kabul, Afghanistan
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Hoque DME, Arifeen SE, Rahman M, Chowdhury EK, Haque TM, Begum K, Hossain MA, Akter T, Haque F, Anwar T, Billah SM, Rahman AE, Huque MH, Christou A, Baqui AH, Bryce J, Black RE. Improving and sustaining quality of child health care through IMCI training and supervision: experience from rural Bangladesh. Health Policy Plan 2013; 29:753-62. [PMID: 24038076 DOI: 10.1093/heapol/czt059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities. OBJECTIVES To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision. METHODS Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities. FINDINGS Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities. CONCLUSION IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.
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Affiliation(s)
- D M Emdadul Hoque
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shams E Arifeen
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Muntasirur Rahman
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Enayet K Chowdhury
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Twaha M Haque
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khadija Begum
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Altaf Hossain
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tasnima Akter
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fazlul Haque
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tariq Anwar
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sk Masum Billah
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ahmed Ehsanur Rahman
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Md Hamidul Huque
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aliki Christou
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abdullah H Baqui
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Bryce
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert E Black
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pradhan NA, Rizvi N, Sami N, Gul X. Insight into implementation of facility-based integrated management of childhood illness strategy in a rural district of Sindh, Pakistan. Glob Health Action 2013; 6:20086. [PMID: 23830574 PMCID: PMC3703511 DOI: 10.3402/gha.v6i0.20086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 11/23/2022] Open
Abstract
Background Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition – the main targets of the strategy. Objective The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. Design An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n=5), implementers and managers at a district level (n=3), and IMCI-trained physicians posted at PHC facilities (n=8). Quantitative part included PHC facility survey (n=16) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. Results The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities’ survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed facilities had 75% of the total supplies, while 4 out of 16 facilities had 56% of the required IMCI drug stock. The mean availability of supplies ranged from 36.6 to 66%, while the mean availability of drugs ranged from 45.8 to 56.7%. Conclusion Our findings indicate that the Matiari district has sound implementation potential; however, bottlenecks at health care facility and at health care management level have badly constrained the implementation process. An interdependency exists among the constraining factors, such as lack of sound planning resulting in unclear understanding of the strategy; leading to ambiguous roles and responsibilities among stakeholders which manifest as inadequate availability of supplies and drugs at PHC facilities. Addressing these barriers is likely to have a cumulative effect on facilitating IMCI implementation. On the basis of these findings, we recommend that the provincial Ministry of Health (MoH) and provincial Maternal Neonatal and Child Health (MNCH) program jointly assess the situation and streamline IMCI implementation in the district through sound planning, training, supervision, and logistic support.
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Does integrated management of childhood illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis. PLoS One 2013; 8:e66030. [PMID: 23776599 PMCID: PMC3680429 DOI: 10.1371/journal.pone.0066030] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 05/05/2013] [Indexed: 12/04/2022] Open
Abstract
Background An estimated 6.9 million children die annually in low and middle-income countries because of treatable illneses including pneumonia, diarrhea, and malaria. To reduce morbidity and mortality, the Integrated Management of Childhood Illness strategy was developed, which included a component to strengthen the skills of health workers in identifying and managing these conditions. A systematic review and meta-analysis were conducted to determine whether IMCI training actually improves performance. Methods Database searches of CIHAHL, CENTRAL, EMBASE, Global Health, Medline, Ovid Healthstar, and PubMed were performed from 1990 to February 2013, and supplemented with grey literature searches and reviews of bibliographies. Studies were included if they compared the performance of IMCI and non-IMCI health workers in illness classification, prescription of medications, vaccinations, and counseling on nutrition and admistration of oral therapies. Dersminion-Laird random effect models were used to summarize the effect estimates. Results The systematic review and meta-analysis included 46 and 26 studies, respectively. Four cluster-randomized controlled trials, seven pre-post studies, and 15 cross-sectional studies were included. Findings were heterogeneous across performance domains with evidence of effect modification by health worker performance at baseline. Overall, IMCI-trained workers were more likely to correctly classify illnesses (RR = 1.93, 95% CI: 1.66–2.24). Studies of workers with lower baseline performance showed greater improvements in prescribing medications (RR = 3.08, 95% CI: 2.04–4.66), vaccinating children (RR = 3.45, 95% CI: 1.49–8.01), and counseling families on adequate nutrition (RR = 10.12, 95% CI: 6.03–16.99) and administering oral therapies (RR = 3.76, 95% CI: 2.30–6.13). Trends toward greater training benefits were observed in studies that were conducted in lower resource settings and reported greater supervision. Conclusion Findings suggest that IMCI training improves health worker performance. However, these estimates need to be interpreted cautiously given the observational nature of the studies and presence of heterogeneity.
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Mitchell M, Getchell M, Nkaka M, Msellemu D, Van Esch J, Hedt-Gauthier B. Perceived improvement in integrated management of childhood illness implementation through use of mobile technology: qualitative evidence from a pilot study in Tanzania. JOURNAL OF HEALTH COMMUNICATION 2012; 17 Suppl 1:118-127. [PMID: 22548605 DOI: 10.1080/10810730.2011.649105] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study examined health care provider and caretaker perceptions of electronic Integrated Management of Childhood Illness (eIMCI) in diagnosing and treating childhood illnesses. The authors conducted semi-structured interviews among caretakers (n = 20) and health care providers (n = 11) in the Pwani region of Tanzania. This qualitative study was nested within a larger quantitative study measuring impact of eIMCI on provider adherence to IMCI protocols. Caretakers and health care workers involved in the larger study provided their perceptions of eIMCI in comparison with the conventional paper forms. One health care provider from each participating health center participated in qualitative interviews; 20 caretakers were selected from 1 health center involved in the quantitative study. Interviews were conducted in Swahili and lasted 5-10 min each. Providers expressed positive opinions of eIMCI, noting that the personal digital assistants were faster and easier to use than were the paper forms and encouraged adherence to IMCI procedures. Caretakers also held a positive view of eIMCI, noting improved service from providers, more thorough examination of their child, and a perception that providers who used the personal digital assistants were more knowledgeable. Research indicates widespread nonadherence to IMCI guidelines, suggesting improved methods for implementing IMCI are necessary. The authors conclude that eIMCI represents a promising method for improving health care delivery because it improves health care provider and caretaker perception of the clinical encounter. Further investigation into this technology is warranted.
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Affiliation(s)
- Marc Mitchell
- Department of Global Health and Populations, Harvard School of Public Health, and D-Tree International, Boston, Massachusetts, USA
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Mushi HP, Mullei K, Macha J, Wafula F, Borghi J, Goodman C, Gilson L. The challenges of achieving high training coverage for IMCI: case studies from Kenya and Tanzania. Health Policy Plan 2011; 26:395-404. [PMID: 21047808 PMCID: PMC3157918 DOI: 10.1093/heapol/czq068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2010] [Indexed: 10/25/2022] Open
Abstract
Health worker training is a key component of the integrated management of childhood illness (IMCI). However, training coverage remains low in many countries. We conducted in-depth case studies in two East African countries to examine the factors underlying low training coverage 10 years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007-08. Bunda and Malindi achieved higher levels of training coverage (44% and 25%) compared with Tarime and Homa Bay (5% and 13%). Key factors allowing the first two districts to perform better were: strong district leadership and personal commitment to IMCI, which facilitated access to external funding and encouraged local-level policy adaptation; sensitization and training of district health managers; and lower staff turnover. However, IMCI training coverage remained well below target levels across all sites. The main barrier to expanding coverage was the cost of training due to its duration, the number of facilitators and its residential nature. Mechanisms for financing IMCI also restricted district capacity to raise funds. In Tanzania, districts could not spend more than 10% of their budgets on training. In Kenya, limited financial decentralization meant that district managers had to rely on donors for financial support. Critically, the low priority given to IMCI at national and international levels also limited the expansion of training. Levels of domestic and donor support for IMCI have diminished over time in favour of vertical programmes, partly due to the difficulty in monitoring and measuring the impact of an integrated intervention like IMCI. Alternative, lower cost methods of IMCI training need to be promoted, and greater advocacy for IMCI is needed both nationally and internationally.
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Goga AE, Muhe LM. Global challenges with scale-up of the integrated management of childhood illness strategy: results of a multi-country survey. BMC Public Health 2011; 11:503. [PMID: 21708029 PMCID: PMC3155839 DOI: 10.1186/1471-2458-11-503] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 06/27/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Integrated Management of Childhood Illness Strategy (IMCI), developed by WHO/UNICEF, aims to contribute to reducing childhood morbidity and mortality (MDG4) in resource-limited settings. Since 1996 more than 100 countries have adopted IMCI. IMCI case management training (ICMT) is one of three IMCI components and training is usually residential over 11 consecutive days. Follow-up after ICMT is an essential part of training. We describe the barriers to rapid acceleration of ICMT and review country perspectives on how to address these barriers. METHODS A multi-country exploratory cross-sectional questionnaire survey of in-service ICMT approaches, using quantitative and qualitative methods, was conducted in 2006-7: 27 countries were purposively selected from all six WHO regions. Data for this paper are from three questionnaires (QA, QB and QC), distributed to selected national focal IMCI persons/programme officers, course directors/facilitators and IMCI trainees respectively. QC only gathered data on experiences with IMCI follow-up. RESULTS 33 QA, 163 QB and 272 QC were received. The commonest challenges to ICMT scale-up relate to funding (high cost and long duration of the residential ICMT), poor literacy of health workers, differing opinions about the role of IMCI in improving child health, lack of political support, frequent changes in staff or rules at Ministries of Health and lack of skilled facilitators. Countries addressed these challenges in several ways including increased advocacy, developing strategic linkages with other priorities, intensifying pre-service training, re-distribution of funds and shortening course duration. The commonest challenges to follow-up after ICMT were lack of funding (93.1% of respondents), inadequate funds for travelling or planning (75.9% and 44.8% respectively), lack of gas for travelling (41.4%), inadequately trained or few supervisors (41.4%) and inadequate job aids for follow-up (27.6%). Countries addressed these by piggy backing IMCI follow-up with routine supervisory visits. CONCLUSIONS Financial challenges to ICMT scale-up and follow-up after training are common. As IMCI is accepted globally as one of the key strategies to meet MDG4 several steps need to be taken to facilitate rapid acceleration of ICMT, including reviewing core competencies followed by competency-driven shortened training duration or 'on the job' training, 'distance learning' or training using mobile phones. Linkages with other 'better-funded' programmes e.g. HIV or malaria need to be improved. Routine Primary Health Care (PHC) supervision needs to include follow-up after ICMT.
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Affiliation(s)
- Ameena E Goga
- Health Systems Research Unit, Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001 Pretoria, South Africa
| | - Lulu M Muhe
- Department of Child and Adolescent Health and Development (CAH), World Health Organisation, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Rowe AK, Rowe SY, Holloway KA, Ivanovska V, Muhe L, Lambrechts T. Does shortening the training on Integrated Management of Childhood Illness guidelines reduce its effectiveness? A systematic review. Health Policy Plan 2011; 27:179-93. [PMID: 21515912 DOI: 10.1093/heapol/czr033] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Implementation of the Integrated Management of Childhood Illness (IMCI) strategy with an 11-day training course for health workers improves care for ill children in outpatient settings in developing countries. The 11-day course duration is recommended by the World Health Organization, which developed IMCI. Our aim was to determine if shortening the training (to reduce cost) reduces its effectiveness. METHODS We conducted a systematic review to compare IMCI's effectiveness with standard training (duration ≥ 11 days) versus shortened training (5-10 days). Studies were identified from a search of MEDLINE, two existing systematic reviews, and by contacting investigators. We included published or unpublished studies that evaluated IMCI's effectiveness in developing countries and reported quantitative measures of health worker practices related to managing ill children under 5 years old in public or private health facilities. Summary measures were the median of effect sizes for all outcomes from a given study, and the percentage of patients needing oral antimicrobials or rehydration who were treated according to IMCI guidelines. FINDINGS Twenty-nine studies were included. Direct comparisons from three studies showed little difference between standard and shortened training. Indirect comparisons from 26 studies revealed that effect sizes for standard training versus no IMCI were greater than shortened training versus no IMCI. Across all comparisons, differences ranged from -3 to +23 percentage-points, and our best estimate was a 2 to 16 percentage-point advantage for standard training. No result was statistically significant. After IMCI training (of any duration), 34% of ill children needing oral antimicrobials or rehydration were not receiving these treatments according to IMCI guidelines. CONCLUSIONS Based on limited evidence, standard IMCI training seemed more effective than shortened training, although the difference might be small. As sizable performance gaps often existed after IMCI training, countries should consider implementing other interventions to support health workers after training, regardless of training duration.
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Affiliation(s)
- Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, GA 30341-3724, USA.
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National implementation of Integrated Management of Childhood Illness (IMCI): policy constraints and strategies. Health Policy 2010; 96:128-33. [PMID: 20176407 DOI: 10.1016/j.healthpol.2010.01.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 01/20/2010] [Accepted: 01/24/2010] [Indexed: 11/22/2022]
Abstract
Integrated Management of Childhood Illness (IMCI) is a pediatric care management strategy that has been shown to improve health care service quality and increase health care cost savings in multi-country evaluations. However, many countries have faced significant training, health system, political, and financial constraints to national implementation and, as a result, have not been able to observe sustained benefits of IMCI. This article reviews the literature for evidence of IMCI health impacts, common implementation constraints, and policy strategies for health system strengthening and successful implementation.
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