Primary Health Care Physicians' Adherence and Attitude Towards Integrated Management of Childhood Illness Guidelines in Alexandria Governorate in Egypt.

Ahmed A El-Ayady,Rania S Ismaiel,Marwa M Ahmed,Dorreya E Meleis

doi:10.5539/gjhs.v8n5p217

Abstract

Background:Integrated Management of Childhood Illness (IMCI) is a cost-effective strategy that improves the quality of care provided to under-five children. Alexandria was the first governorate that applied the Integrated Management of Childhood Illness guidelines in Egypt. The aim of this study was to assess the degree of primary health care physicians’ adherence and attitude towards those guidelines after 17 years of application.Methods:This cross-sectional study was carried out on a representative sample from the primary health care facilities in Alexandria from which physicians using IMCI guidelines were included in the study. The sample units were chosen randomly from all districts of Alexandria. Observational checklists were developed to assess the degree of adherence of physicians based on the guidelines booklet.Results:The highest adherence score reported was that of writing disease classification (100%). As regards infants aged up to 2 months, the highest physicians’ adherence score reported was that of jaundice and possible bacterial infection assessment (100% and 95% respectively). And in spite of its importance, only 85.7% of physicians were complied with weight assessment and its plotting in the growth curve. For children aged from 2 months up to 5 years physicians were generally well complied with the guidelines especially for assessment of dangerous signs and possible bacterial infection.Conclusion:Despite being applied for years, IMCI guidelines still show certain areas of poor adherence, an issue that need further investigation in order to maximize physicians’ adherence and achieve the best of their performance.

Highlights

Practice guidelines have been developed by ministries of health, medical institutes and many local organizations in an attempt to reduce undesirable variation of health care and to improve its quality (Hyams, Shapiro, Brandenburg, & Brenan, 1996)
The highest adherence score reported was that of writing disease classification (100%)
For children aged from 2 months up to 5 years physicians were generally well complied with the guidelines especially for assessment of dangerous signs and possible bacterial infection

Summary

Introduction

Practice guidelines have been developed by ministries of health, medical institutes and many local organizations in an attempt to reduce undesirable variation of health care and to improve its quality (Hyams, Shapiro, Brandenburg, & Brenan, 1996). Since the early 1980s symptom specific algorithms and training programs have been developed by the World Health Organization (WHO) and incorporated into the national health programs of many developing countries (Perkins et al, 1997). The integrated management of childhood illness (IMCI) is one of these algorithms which were developed to address the most common causes of morbidity and mortality among children in developing countries (Bern, Zucker, & Perkins, 1997). In Egypt IMCI was introduced in 1997 and Alexandria was the first governorate started applying IMCI guidelines in the primary health care units Integrated Management of Childhood Illness (IMCI) is a cost-effective strategy that improves the quality of care provided to under-five children. Alexandria was the first governorate that applied the Integrated Management of Childhood Illness guidelines in Egypt. The aim of this study was to assess the degree of primary health care physicians’ adherence and attitude towards those guidelines after 17 years of application

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Discussion

Conclusion