The Integrated Management of Childhood Illness (IMCI) – Beyond Mortality Reduction IMCI and Its Potential to Reduce the Misuse of Antibiotics

Abstract

The Integrated Management of Childhood Illness (IMCI) was introduced in Central Asia and Europe to address the absence of evidence-based guidelines, antibiotics misuse, polypharmacy and over-hospitalization. The study carried out in 16 countries analysed status, strengths of and barriers to IMCI implementation and investigated how health systems affect the problems IMCI aims to address. Here we present findings in relation to implications on the rational use of drugs, particularly the improved rational use of antibiotics for children, the mechanisms through which these were achieved as well as counteracting system factors. Methods: 220 key informants were interviewed ranging from 5 to 37 per country (median 12). Data was analysed for arising themes and peer-reviewed. Findings: The use of IMCI as an algorithmic diagnostic- and treatment-decision-tool led to better prescribing patterns immediately after training according to key informants by - Providing a standard treatment guideline and job-aid for consistent decision-making - Counselling training for addressing parents´ expectations and desires for invasive treatments and use of multiple drugs Improved prescribing patterns were not sustained over time but counteracted by factors such as - Doctors prescribing antibiotics to create additional revenues or other benefits - Aggressive marketing by pharmaceutical companies - Parents pressuring doctors to prescribe antibiotics - Access to drugs without prescriptions. Interpretation: The revised IMCI strategy must include -Continued support to improve health worker performance enabling them to adhere to evidence-based treatment guidelines -Patient and parent education -Improved regulations and their consistent enforcement -The integration of point–of-care tests differentiating between viral and bacterial infection into the IMCI algorithm. Pre-requisites will be sufficient remuneration, sound training, improved health literacy among parents, conducive laws and regulations and reimbursement systems with adequate checks and balances to ensure the best possible care. Funding Statement: This work was commissioned by the WHO Regional office for Europe and funded by the Bill and Melinda Gates Foundation. Declaration of Interests: Most of the authors are or were WHO staff members and at some stage involved in the implementation of IMCI. No other competing interests declared. Ethics Approval Statement: This study was deemed exempt from ethical review by the WHO Ethics Review Committee (ERC.0002743003540/13).