The Implementation of Integrated Management of Childhood Illness ...

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countries in Africa, i.e. around half of the population is children and a small proportion is elderly people. The fertility rate is high and one out of five children dies before the age of five (42). Table 3-1: Malawi demographic figures (39, 42, 43). Population Age structure Life expectancy Child mortality Fertility rate 1998 census 9.9 million Current estimate 12 million Population growth rate 2.06% Children (0-14 years) 46.9 % Adults (15-64 years) 50.4 % Elderly (over 65 years) 2.8 % 37 years Infant mortality 103 per 1,000 live births Under five mortality 190 per 1,000 live births 6.0 births per woman HIV prevalence 14.2 % Malawians have access to a state-run health care system. Every Malawian should, therefore, have the chance of free health care and basic health services. This is a difficult task to execute in a country where the funds and human resources in the health sector are limited. In addition to the government-run health facilities, there are numerous private clinics and hospitals in Malawi. These are either supported by the government or entirely run by private funds. In general, these private facilities charge for health services (44). The primary level of health care is provided by health centres and rural hospitals which do not have medical doctors but have staff with clinical training (e.g. Medical Assistants and Clinical Officers) and nurse technicians (45). Medical assistants (MAs) have two years of training in diagnosis and treatment. A secondary school degree is a prerequisite for their education. Most MAs work on primary level of health care or at district level. Clinical Officers (COs) are trained for four years in diagnosis and treatment. Their training is more intense than that of MAs and involves training in Ceasarean sections. Nurse technicians have two years of higher-level education but do not graduate with a degree. By completing one more year of education, the nurse technicians are upgraded to nurse/midwife-technicians (45). In all 27 districts there are district hospitals. The district hospitals have more sophisticated diagnostic equipment. They also have a medical doctor and can 22
perform surgical procedures. Illnesses that cannot be treated at the district level are referred to one of the three central hospitals, which have the best trained health workers (medical doctors, nurses with university degrees, etc.) and the most advanced diagnostic equipment (44). In Malawi, IMCI is implemented on a national level. It was introduced in 1998 and a second edition of the guidelines was released in 1999 (46). ii. Mangochi District Mangochi District is located in the southern part of Malawi. Based on the 1998 census, it is estimated that the population of Mangochi district is now around 730,000 (47). The Government of Malawi runs 23 health facilities and two hospitals in the Figure 3-2 Mangochi District Hospital district, Mangochi District Hospital and Monkey Bay Community Hospital (48). Mangochi District Hospital (Figure 3-2) is the principal referral hospital for all health facilities in Mangochi District. It is a 279 bed hospital that has the capacity to perform surgical procedures and employs clinicians, nurses, and one medical doctor (49). Around 400 patients attend the outpatient department every day (personal communication, Lovísa Leifsdóttir, technical advisor at MBCH). In Mangochi, 109/179 health care workers are trained in IMCI, or 64% (personal communication, Joyce Chausa, IMCI coordinator in Mangochi District). The implementation of IMCI in Mangochi has fared well. The major problems and obstacles are high turn over of staff, poor communication among health facilities, and lack of equipment and drugs (personal communication, Joyce Chausa). iii. Monkey Bay health zonee Monkey Bay is a town in northern Mangochi district, which is situated on a peninsula that cuts through the southernmost part of Lake Malawi (see Figure 2-1). The Monkey Bay health zone is an area around Monkey Bay with a population of 23
Page 1 and 2: The Implementation of Integrated Ma
Page 3 and 4: . Diagnoses .......................
Page 5 and 6: List of Abbreviations ARI………
Page 7 and 8: Since 1970 there has been a conside
Page 9 and 10: over half of all deaths associated
Page 11 and 12: (16). The vertical programmes were
Page 13 and 14: The case-management guidelines are
Page 15 and 16: The childhood deaths resulting from
Page 17 and 18: though ear infection is not one of
Page 19 and 20: guidelines after training seems unn
Page 21: 3. Material and Methods a. The Sett
Page 25 and 26: workload at the Mangochi District h
Page 27 and 28: The respiratory tract infections in
Page 29 and 30: 4. Results a. Health Care Workers I
Page 31 and 32: In all health facilities there were
Page 33 and 34: c. Diagnoses Children could be clas
Page 35 and 36: Pro ii. Pneumonia In total, about 7
Page 37 and 38: iv. Diarrhoea As shown in Figure 4-
Page 39 and 40: Table 4-10: Availability of IMCI-re
Page 41 and 42: 5. Discussion The results of this s
Page 43 and 44: . Diagnoses The fact that around 84
Page 45 and 46: This is interesting in the light of
Page 47 and 48: In the present study, of the just l
Page 49 and 50: eceived care from the trained healt
Page 51 and 52: Acknowledgments This project is a c
Page 53 and 54: area of Kenya with high malaria tra
Page 55 and 56: 53. Creese A, Kutzin J. Lessons fro
Page 57 and 58: Annexes 57
Page 59 and 60: Annex 2 59
Page 61 and 62: Annex 4 61

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