The Implementation of Integrated Management of Childhood Illness ...

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Abstract Introduction The under-five (U5) mortality in the world today exceeds 10 million children per year. The majority of these deaths are the result of preventable diseases, e.g. malaria, acute respiratory infections, diarrhoea, measles, compounded with malnutrition. Most of these deaths occur in developing countries, in particular sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) was developed for settings where child mortality is high and where simple and inexpensive solutions are needed. IMCI enables, with the help of a flow-chart, health care workers in outpatient settings to classify the health problems in U5s and provide them with appropriate care and treatment. Objective Describe and analyse the outpatient settings for children in a sub-Saharan country with focus on the implementation of IMCI. Methods The study was conducted in the Monkey Bay health zone in Malawi. The Icelandic International Development Agency (ICEIDA) has been supporting the health sector in the area since the year 2000. In the area there are five health facilities. Two of them are run by the government and offer services free of charge while three are run by the Christian Health Association of Malawi (CHAM) and charge user fees. Data about all children’s attendances and illness classifications during March 2005 was collected from Outpatient Registers in each of the health facilities. Drug inventories were taken at each health centre. Health workers who consult children were interviewed about IMCI. Guardians of 11 children were interviewed at the Monkey Bay Community Hospital (MBCH). Results State run facilities were more frequented than those run by CHAM. Based on population data in the catchment areas of each the health facilities, the population of all ages was 1.45 times more likely (RR, 95% CI: 1.43-1.47) to visit a state-run facility than a CHAM-run facility. Children were 1,22 times more likely (RR, 95% CI 1.18-1.26) to be brought to a state run health facility than a CHAM-run one. At the government-run facilities, about ¼ of the attendees were U5s compared to about half in the private and user-charging health facilities. Around 4/5 of all classifications for sick children less than five years were dealt with in the IMCI. More than half of all the attending children were classified as having malaria while pneumonia and other respiratory tract infections were used classifications for about 1/3 of attending children. One case of malnutrition was reported and seven cases of anaemia. Eight out of ten health workers who consult children in the Monkey Bay area are trained in IMCI; seven use the IMCI guidelines in practice. The drug inventories revealed that most oral IMCIrecommended drugs were in stock while intramuscular antibiotics were not. Discussion The relatively higher attendance to the government-run facilities may indicate that patients prefer facilities that do not charge for services despite occasional drug shortages. The majority of attendees less than five years of age presented with problems that are dealt with in the IMCI flow-chart which supports the notion that IMCI is appropriate in the setting. The high number of malaria cases may indicate mis-classifications. The low number of anaemia and malnutrition classifications calls for improvement in assessment of children regarding these conditions. It is important that all health workers receive IMCI training, appropriate supervision and are given necessary equipment and support to adequately attend sick children. 4
List of Abbreviations ARI………………………… acute respiratory infection CHAM…………………….. Christian Health Association of Malawi CI…………………………... confidence interval CO…………………………. Clinical Officer HC…………………………. health centre HIV/AIDS………………… Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome ICEIDA……………………. Icelandic International Development Agency IMCI……………………….. Integrated Management of Childhood Illness MA…………………………. Medical Assistant MDG……………………….. Millennium Development Goal MBCH……………………... Monkey Bay Community Hospital OPD………………………... Out-Patient Department ORS………………………… Oral Rehydration Salts RR………………………….. relative risk SP…………………………... sulphadoxine pyrimethamine U5………………………….. children under five years of age UNICEF…………………… United Nations Children′s Fund WHO………………………. World Health Organization 5
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53. Creese A, Kutzin J. Lessons fro
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Annexes 57
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Annex 2 59
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Annex 4 61
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