The Implementation of Integrated Management of Childhood Illness ...

v. Ear Infection
The ear infection-classification was quite low during the research period, or only
given to 1.4% of all attending children. Ear infections were most commonly reported
in children between 1-4 years. The reason for the low proportion of ear infectionclassifications
in children aged less than one year is likely to be a result of missed
cases.
Otitis media is a common problem in children younger than one year in
developed countries. In Ethiopia, a developing country, it was found that 10% of
presenting complaints of the children or mothers was ear problems (57). The fact that
the IMCI does not rely on otoscopy necessitates a very careful assessment of whether
the child has ear pain and whether pus is draining from the ear. It is difficult to
assess whether children less than 1 year old have ear pain or not and therefore many
of the cases may be missed. Diagnosis of otitis media has been reported poor in
countries implementing IMCI because of the lack of otoscopy (18). Improvements
need to be made in detection of otitis media, especially in younger children.
vi. Malnutrition and anaemiaa
Malnutrition and anaemia are common and serious problems in Africa. A study
in Malawi’s neighbouring country Tanzania, showed that 87% of under-fives had
some level of anaemia if haemoglobin levels were measured (66). In Kenya it was
found that 80% of the children attending the outpatient department met the WHO
criteria for anaemia (less than 11 g/dl) (18). A study in Southern Malawi showed
that the mean hemoglobin level in children aged 2-4 years was 83.8 g/L, standard
deviation 12.9 (67).
During the research period seven children were given the classification anaemia,
which is very low considering the statistics above. However, this is a comparision of
a measured haemoglobin level with a clinical assessment of anaemia. It may be
difficult for health workers to identify children with anaemia based on clinical signs
such as palmar pallor. In Tanzania it was found that anaemia often goes unnoticed
in children (66), which is probably the situation in the Monkey Bay area as well.
Also, since anaemia is usually a chronic state in children in Africa, it may not be
perceived as a disease.
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