The Implementation of Integrated Management of Childhood Illness ...

guidelines after training seems unnecessary as health workers have changed their
practices through training in IMCI (16). Further, health workers that attend to
children have welcomed a systematisation in assessing and treating sick children
(16).
While the IMCI guidelines were largely based on research and studies have
provided a technical validation of the algorithm, the effectiveness, impact and
relative cost of IMCI must likewise be assesed. Presently, a Multi-Country
Evaluation of IMCI is being conducted in five countries in three different regions of
the world: Bangladesh, Brazil, Peru, Tanzania, and Uganda (23). Its purpose is to
examine the effectiveness, cost, and impact of IMCI in these five countries.
Schellenberg et al. reported, in 2004, the first results that confirm a child mortality
reduction as a result of the implementation of IMCI (35). Their study, which is a part
of the Multi-Country Evaluation of IMCI, showed a 13% lower child mortality in two
districts implementing IMCI than in two districts that did not implement IMCI.
Another study has shown that IMCI was not more expensive than the standard
health care provided in control districts (36).
The IMCI programme will not be successful unless the quality of services is
assured. Gouws et al. recently suggested a new set of indices to measure the quality
of child health-care at first-level facilities (37). These four indices have the highest
validity and reliability of hitherto proposed indices and include: A. integrated child
assessment; B. availability of vaccines; C. availability of oral and injectable drugs; D.
primary health care worker′s knowledge of correct case management for severe
illness and young infants. The first and last indices can be improved by
implementation of IMCI and the other two are essential for proper functioning of the
IMCI algorithm (37).
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