Abstract
BackgroundAn 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.MethodsDatabase 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.ResultsThe 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.ConclusionFindings 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.
Highlights
The worldwide child mortality rate has declined by two-fifths since 1990 [1], an estimated 6.9 million children under the age of five still die annually in low and middle income countries (LMIC) because of preventable and treatable illnesses including pneumonia, diarrheal disease, malaria, and underlying malnutrition [2,3]
In an effort to reduce pediatric morbidity and mortality, the World Health Organization (WHO) and other technical partners developed the Integrated Management of Childhood Illness (IMCI), an evidence-based strategy comprised of strengthening the skills of health workers, the health system, and family and community health practices [4,5]
To identify pertinent, unpublished grey literature, we conducted supplemental searches using the websites of the WHO Library Database (WHOLIS), WHO Department of Child and Adolescent Health and Development and its regional offices, IMCI Multi-Country Evaluation (MCE) research group, Department for International Development (DFID), United States
Summary
The worldwide child mortality rate has declined by two-fifths since 1990 [1], an estimated 6.9 million children under the age of five still die annually in low and middle income countries (LMIC) because of preventable and treatable illnesses including pneumonia, diarrheal disease, malaria, and underlying malnutrition [2,3]. Recent evaluations suggest that IMCI has fallen somewhat short of expectations given the low population coverage, fragmented health systems, and weak community health promotion [16,17,18,19]. It remains unclear whether training consistently improved skills in other domains such as vaccinations and nutrition counseling, and if so, the magnitude of these benefits. Underpinning these issues, is the adequacy of IMCI implementation. A systematic review and meta-analysis were conducted to determine whether IMCI training improves performance
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