Abstract
Background: The World Health Organization (WHO) build up guidelines for the integrated management of childhood illnesses (IMCI) in the health facilities to improve the recognition and the individual management of the common reasons of death among children under the age of five. The approach used in outpatient clinical settings with restricted diagnostic and therapeutic tools. Aim of study: To assess the impact of implementation of IMCI strategy, in reducing an inappropriate prescription of antibiotics and raising vaccination coverage. Patients and methods: A cross-sectional study design was arranged, where 395 child with age from two months up to below 5 years old attending Al Hadbaa PHCC from 1st of January to 31st of March 2014 suffering from one or more of the following respiratory infection, diarrheal diseases, throat infections, ear infections and fever. The children assessed separately by two clinics, "A" non-adopting IMCI and "B" adopting IMCI guidelines, the Mc-Nemar test was applied and differences were evaluated. Results: The attendant children are 239 males and 156 females complaining from fever (39.1%), throat problems (21.4%), ear problems (12.6%), cough (11.6%), diarrhea (11.1%) and pneumonia (4.2%). The overall use of antibiotics is 66.1% in clinic "A" and 21.0% in clinic "B" with p-value 0.000. Regarding the immunization, the outcomes appear to have very high significant difference 54.1% in "A" and 75.7% in "B". Conclusion: The classification-approach to the sick child using IMCI guidelines has clear effect on decreasing an inappropriate use of antibiotics and raising number of vaccinated children, which justifying the adaptation of this strategy.
Highlights
A lmost 11 million of children below the age of five years living in the developing countries die every year, the death occurs in 7 from every 10 of those result from the common illnesses affecting children as acute respiratory infections (ARI), diarrhea, dehydration, measles, and malaria
In Egypt 2011 with frequencies of 89.3%, 87.3%, 91.3%, and 91.3%, respectively than in the clinic not adopting[16], and the injectable drugs were decided to be used in only 0.7% of cases in clinic "A" adopting integrated management of childhood illnesses (IMCI), this may be a benefit of adopting IMCI because the cost of injection therapy is always higher than that of oral therapy, in the present work, the ratio of the injectable antibiotics from the total antibiotic prescription was low in clinic "B" in comparison with clinic "A", this is run in a very high significant difference, this can be explained by the fact that the injectable antibiotics prescription in IMCI, has been conserved to the child with sever classifications who need urgent referral to hospital
In several studies[18,19,20], the results showed low specificity of IMCI algorithms, especially to identify bacterial infections that require antibiotics this limitations in IMCI could be explained by the defect in the available diagnostic tools or lack the concerning about the local epidemiology
Summary
A lmost 11 million of children below the age of five years living in the developing countries die every year, the death occurs in 7 from every 10 of those result from the common illnesses affecting children as acute respiratory infections (ARI), diarrhea, dehydration, measles, and malaria. All these illnesses are both preventable and treatable. The World Health Organization (WHO) build up guidelines for the integrated management of childhood illnesses (IMCI) in the health facilities to improve the recognition and the individual management of the common reasons of death among children under the age of five. Conclusion: The classification-approach to the sick child using IMCI guidelines has clear effect on decreasing an inappropriate use of antibiotics and raising number of vaccinated children, which justifying the adaptation of this strategy
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