The effect of training in Integrated Management of Childhood Illness (IMCI) on the performance and healthcare quality of pediatric healthcare workers: a systematic review

João Joaquim Freitas Do Amaral,Cesar Gomes Victora

doi:10.1590/s1519-38292008000200002

Abstract

OBJECTIVES: to analyze the effect of training in Integrated Management of Childhood Illness (IMCI) on the quality of case management by healthcare workers based on a systematic review of the literature. METHODS: the authors searched the databases MEDLINE, LILACS, PAHO and WHOLIS for the search terms Integrated Management of Childhood Illness (IMCI), and analyzed documents published by Pan American Health Organization, World Health Organization and the Brazilian Ministry of Health between January 1993 and July 2006. The quality of the methodology was assessed using the criteria developed by Downs and Black. RESULTS: thirty-five papers were reviewed. Twelve of these validated the IMCI algorithm and found the sensitivity to be high and the specificity to be over 80% for major illnesses. Twenty-three papers assessed the performance of healthcare workers, eight of these with no control group. The present study shows clear evidence of improvement in the performance of healthcare workers employed at healthcare facilities with IMCI. The main methodological weaknesses of the study were lack of control of confounding factors and lack of information regarding statistical power. CONCLUSIONS: the performance of healthcare workers tends to improve at public healthcare facilities when IMCI is introduced.

Highlights

The Integrated Management of Childhood Illness (IMCI) strategy was drawn up by the World Health Organization (WHO) in collaboration with the United Nations Children's Fund (UNICEF) with the aim of improving child health indicators
A list of these 33 articles can be found in Table 1, Table 2 and Table 3
The first studies carried out were validation studies, as it was necessary to evaluate the discriminatory power of the IMCI algorithm before introducing it into other countries

Summary

Introduction

The Integrated Management of Childhood Illness (IMCI) strategy was drawn up by the World Health Organization (WHO) in collaboration with the United Nations Children's Fund (UNICEF) with the aim of improving child health indicators. The IMCI strategy includes training of health workers in the management of diseases common in childhood, with emphasis on diarrhea, respiratory infections, malaria, measles and malnutrition. The IMCI strategy has already been introduced in more than 100 countries,[5] so far no systematic review of the literature has evaluated whether there has been an improvement in the performance of health workers subsequent to the introduction of this strategy. Such information would be extremely useful for planners and policy-makers in the area of child health.

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Conclusion