Integrated Management Of Childhood Illness Programme Research Articles

Family Participation in The Integrated Management of Childhood Illness Implementation Process: Systematic Literature Review

This study aims to analyze the role and contribution of families in the implementation of Integrated Management of Childhood Illness (IMCI) and the impact of family participation on child health outcomes. In addition, this study also identified factors that support or hinder family participation in the IMCI program. The method used was a systematic literature review of various published studies. The method used is a systematic literature review with the main data source of 15 previous studies on the theme to be examined in this study so that the data makes a new finding. The main findings of this study show that family education, social and community support, health policies, and family experiences and perceptions of IMCI are important themes that influence the successful implementation of IMCI. Effective education of families improves their understanding and skills in managing childhood illnesses, while support from health workers and the community can increase family participation in IMCI programs. Supportive health policies and appropriate interventions also play an important role in ensuring the program's effectiveness. However, lack of motivation and adequate information from health workers can be barriers to family participation. This study confirms the importance of active family participation in IMCI implementation to improve child health outcomes. Recommendations for further research include evaluation of the most effective educational methods, the influence of technology in supporting IMCI, and longitudinal studies to monitor the long-term impact of family participation. From a health policy perspective, improved training for health workers, strengthened social and community support networks, and improved accessibility of health information through various media are suggested to support better implementation of IMCI programs.

Assessment of factors related to caregivers and children on the IMCI program outcomes in Baghdad City in 2021

Background: The implementation of the Integrated Management of Childhood Illness (IMCI) program has led to enhancement in outcomes for many treatable childhood diseases. This study aims to assess how implementing IMCI affects child mortality and morbidity in Iraq. Methods: A cross-sectional study spanning from January to December 2021 was carried out at primary healthcare centers (PHCCs) with IMCI units in Baghdad, Iraq. Using a lottery sampling method, 40 PHCCs were randomly chosen from a total of 235 centers across both sides of the city. A universal sampling technique was adopted to select all children attending these PHCCs regularly. With a p-value below 5%, multiple logistic regression analyses were performed to identify the significant independent predictors at a 95% confidence interval. Results: The majority of caregivers were mothers (97.8%), aged 20 to 30 years (75.8%), and housewives (59.2%). Sixty percent of children (6 to 35 months) had normal anthropometric measurements. Bottle feeding was common (44.2%), and most children had a normal neonatal history (82.9%). In bivariate analysis, the severity of illness, severe cases of diarrhea, and acute respiratory infection (ARI) showed significant associations with worsened or not improved outcomes (χ2 = 18.900, p < 0.001; χ2 = 6.265, p= 0.016; and χ2 = 7.549, p= 0.003, respectively). However, multiple logistic regression analysis indicated that mild and moderate illness severity (OR = 10.634, 95% CI: 6.985 to 16.192, p < 0.001), strict breastfeeding (OR = 3.307, 95% CI: 1.703 to 6.421, p < 0.001), and completing treatment at home (OR = 6.190, 95% CI: 4.115 to 9.311, p < 0.001) significantly improved outcomes through IMCI services. Conclusion: Severe illness, especially in diarrhea and ARI, correlates with poorer outcomes. Conversely, exclusive breastfeeding, prompt medical attention within a day of illness onset, and completing home treatment are associated with improved outcomes.

Barriers for using amoxycillin dispersible tablet in pediatric pneumonia treatment in Bangladesh

Abstract World Health Organization recommends guideline for integrated management of childhood illnesses (IMCI) where Amoxicillin Dispersible Tablet (DT) appears as the first drug of choice for treating childhood pneumonia. The Government of Bangladesh adopted the IMCI strategy in 1998, and scaled it up nationwide by 2014. But, even today, the use of Amoxicillin DT, either in public or private sector, for managing childhood pneumonia is a rare event in Bangladesh. We conducted this exploratory study to understand the existing barriers, both in public and private sector, those have influences on reduced availability of Amoxicillin DT and non-compliance of health service providers to follow IMCI guideline by using Amoxicillin DT for treating a child with pneumonia, in Bangladesh. We conducted desk review of relevant strategy and policy documents, key informant interviews with 19 key individuals from Ministry of Health and national / international NGOs. Collected information were analyzed and interpreted using thematic analysis method. Identified barriers through this study pointed to inadequate policy level focus on IMCI implementation, non-inclusion of Amoxicillin DT in the national essential drug list, single source of Amoxicillin DT producing pharmaceutical in the country coupled with bureaucracy and procurement procedural complexity, lack of training of health service providers and abundant availability of antibiotic over the counter. Study respondents recommended for policy level strengthening of IMCI program, increasing coverage of training for health care provider, including practicing pediatricians both at public and private sectors, facilitating production and procurement procedures and prohibiting antibiotic sell over the counter. Key messages • Facilitation of production and procurement procedure coupled with enforcement of law prohibiting antibiotics availability over the counter are urgent needs. • Policy level support emphasizing full compliance of service providers for quality of implementation of IMCI program in Bangladesh (and similar other settings) is also important.

Success and time implications of SpO2 measurement through pulse oximetry among hospitalised children in rural Bangladesh: Variability by various device-, provider- and patient-related factors.

BackgroundHypoxaemia is one of the strongest predictors of mortality among children with pneumonia. It can be identified through pulse oximetry instantaneously, which is a non-invasive procedure but can be influenced by factors related to the specific measuring device, health provider and patient. Following WHO's global recommendation in 2014, Bangladesh decided to introduce pulse oximetry in paediatric outpatient services, ie, the Integrated Management of Childhood Illness (IMCI) services in 2019. A national committee updated the existing IMCI implementation package and decided to test it by assessing the pulse oximetry performance of different types of assessors in real-life inpatient settings.MethodsWe adopted an observational design and conducted a technology assessment among children admitted to a rural district hospital. Eleven nurses and seven paramedics received one-day training on pulse oximetry as assessors. Each assessor performed at least 30 pulse oximetry measurements on children with two types of handheld devices. The primary outcome of interest was obtaining a successful measurement of SpO2, defined as observing a stable (±1%) reading for at least 10 seconds. Performance time, ie, time taken to obtain a successful measurement of SpO2 was considered the secondary outcome of interest. In addition, we used Generalized Estimating Equation to assess the effect of different factors on the pulse oximetry performance.ResultsThe assessors obtained successful measurements of SpO2 in all attempts (n = 1478) except one. The median time taken was 30 (interquartile range (IQR) = 22-42) seconds, and within 60 seconds, 92% of attempts were successful. The odds of obtaining a successful measurement within 60 seconds were 7.3 (95% confidence interval (CI) = 3.7-14.2) times higher with a Masimo device than a Lifebox device. Similarly, assessors aged >25 years were 4.8 (95% CI = 1.2, 18.6) times more likely to obtain a successful measurement within 60 seconds. The odds of obtaining a successful measurement was 2.6 (95% CI = 1.6, 4.2) times higher among children aged 12-59 months compared to 2-11 months.ConclusionsOur study indicated that assessors could achieve the necessary skills to perform pulse oximetry successfully in real-life inpatient settings through a short training module, with some effect of device-, provider- and patient-related factors. The National IMCI Programme of Bangladesh can use these findings for finalising the national IMCI training modules and implementation package incorporating the recommendation of using pulse oximetry for childhood pneumonia assessment.

Experiences of Clinic Managers Implementing the Integrated Management of Childhood Illness (IMCI) in Limpopo Province South Africa

ABSTRACT Integrated management of childhood illness (IMCI) strategy was developed for reduction of underfive child mortality. The strategy’s implementation is still inadequate even among trained professional nurses in the presence of clinic managers. A qualitative, descriptive phenomenological research design was used to explore and describe the lived experiences of clinic managers regarding the implementation of the IMCI strategy in Primary health care (PHC) clinics of Limpopo province, South Africa. Semi-structured individual interviews were used to collect data from sixteen (16) purposively selected clinic managers with more than three years of clinic management experience. The seven steps of Collaizi were used to analyse data. Trustworthiness was ensured throughout the study. Positively, managers experienced IMCI as a good strategy which improved nurses’ skills and knowledge, whilst the negative experiences included staff barriers, management barriers and lack of resources that need interventions. Clinic managers to strengthen and prioritise IMCI programme implementation.

\u201cThe staff are not motivated anymore\u201d:\xa0Health care worker perspectives on the Integrated Management of Childhood Illness (IMCI)\xa0program in the Philippines

BackgroundStudies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program. Here, we describe the operational challenges and opportunities described by HCWs implementing IMCI in five regions of the Philippines. These perspectives can provide insights into how IMCI can be strengthened as the program matures, in the Philippines and beyond.MethodsIn-depth interviews (IDIs) were conducted with HCWs (n = 46) in five provinces (Ilocos Sur, Quezon, National Capital Region, Bohol and Davao), with full transcription and translation as necessary. In parallel, data collectors observed the status (availability and placement) of IMCI-related materials in facilities. All data were coded using NVivo 12 software and arranged along a Social Ecological Model.ResultsHCWs spoke of the benefits of IMCI and discussed how they developed workarounds to ensure that integral components of the program could be delivered in frontline facilities. Five key challenges emerged in relation to IMCI implementation in primary health care (PHC) facilities: 1) insufficient financial resources to fund program activities, 2) inadequate training, mentoring and supervision among and for providers, 3) fragmented leadership and governance, 4) substandard access to IMCI relevant written documents, and 5) professional hierarchies that challenge fidelity to IMCI protocols.ConclusionAlthough the IMCI program was viewed by HCWs as holistic and as providing substantial benefits to the community, more viable implementation processes are needed to bolster acceptability in PHC facilities.

Evaluation of Application of Nutritional Status Assessment for Children Under 5 years by Using IMCI Program in a Sample of Primary Health Care Centers in Baghdad City

Background: World Health Organization (WHO) and United Nation International Children Fund (UNICEF) developed a strategy known as Integrated Management of Childhood Illness (IMCI); which aims to reduce less than five years children morbidity and mortality in developing countries.
 Objective: To assess the completion of the IMCI format status in primary health care centers, Baghdad.
 Methods: A cross sectional study with analytic element was conducted during the period from 15th of January till 15th May 2016 in selected Primary health centers in Baghdad, Iraq. The sample consists of form of child files less than 2 months and form from 2 month up to 5 years children. Classified correctively, determined follow up visits, Comparison classified of nutritional status assessment between health center and IMCI guideline.
 Result: 1400 child files were collected, 1295 from child files (2months-5year), and 105 forms from child less than 2 month. In form less than 2 months (correct classified 54.29%, incorrect 45.71%), (Determined date of follow up 13.33%, not determined 86.67%).Form from (2month-5years) (57.07% correct classified, 43.93% incorrect classified), (Determined date Follow up visit 38.38%, Not determined visit 61.62%).
 Conclusion: Impaired classification of nutritional status assessment

204: THE ROLE OF IMCI PROGRAM IN THE RATIONALIZATION OF MEDICAMENT USE IN PEDIATRICS

Background and aims:Integrated management of childhood illness (IMCI) is an EBM guideline prepared by WHO and UNICEF guideline in primary health care for better assessment and management in pediatrics. The...

Utilization of Integrated Management of Childhood Illnesses for Child health in Western Kenya

Implementation of integrated management of childhood illness (IMCI) in comprehensive and holistic, forms bench mark for fifth birth day celebration for child health, free from Malaria, Pneumonia, Diarrhea, Measles and Malnutrition, which was to be achieved through quality Basic and Post-basic IMCI training, willingness of community uptake and perception, and modifying environmental factors to promote MDG 4, vision 2030 in Western Kenya. Cross-sectional design was explored to establish how above determinants influence IMCI. Mixed methods of data collection, procedure was adopted, in quantitative data, structured questionnaire was used, 235 respondents derived by Fishers formulae as sample size, while qualitative data, Focused Group Discussion (FGD) guides and Key informants interviews (KII) were used by forming groups of 8 to 12 discussants. Observations and transect mapping done in partnership with key stakeholders for quality checks from 4 facilities studied. Study population was well mothers attending / presenting their children below five years in level 1 and 2 facilities in study area, besides stakeholders attached to IMCI. Demographical data were also collected. Showed only 14% of under five child health care covers IMCI program contrary to WHO standard of above 68%, (95% CI 0.9 to 5.5%). Evidence seen from limited number of service providers trained in IMCI concepts, low Community uptake and perception and limited efforts to improve environmental factors for child survival at household level. Similar to results from studies identified noteworthy number of children still affected by Malaria, Pneumonia, Malnutrition, diarrhea and Measles.

PROTOCOL: Family and Community Interventions under Integrated Management of Childhood Illness Strategy for Reduction of Neonatal and Under‐five Mortality among Children in Low‐And‐Middle‐Income Countries: A Systematic Review

PROTOCOL: Family and Community Interventions under Integrated Management of Childhood Illness Strategy for Reduction of Neonatal and Under‐five Mortality among Children in Low‐And‐Middle‐Income Countries: A Systematic Review

Impact of Breastfeeding on Infant and Child Mortality with Varying Levels of Immunization and HIV/AIDS: Evidence from 2008/09 Kenya Demographic and Health Survey

Appropriate breastfeeding is one of the cost effective measures in the broader strategy for Integrated Management of Childhood Illness (IMCI) Programme which was adopted by the international community in the 1990s to reduce infant and child mortality especially in developing countries such as Kenya. Although Kenya experienced great improvements towards attainment of full immunization coverage in 1990s and early 2000s, it also experienced high HIV and malaria prevalence rates in some parts of the country during the two decades. This paper used the 2008/09 Kenya Demographic and Health Survey data to analyze the impact of breastfeeding duration in the face of varying levels of immunization coverage and HIV/AIDS risk perception. A total of 6,079 births born 59 months or less preceding the survey were used in the analysis. Life table and generalized linear regression in log linear format were the main methods applied. To determine the breastfeeding effect, other broad community level contextual and socio-economic as well as individual level biological and household environmental factors were controlled for in the analysis. Births in communities with longer breastfeeding duration exceeding 13 months had about 34 per cent lower infant and child mortality when compared with their other counterparts. Longer breastfeeding duration was also found to have beneficial effect on child survival even in lower immunization and higher HIV/AIDS risk situations. Multiple births and those born to mother in widowed/divorced/separated marital status had undesired effect on child mortality. The study results underscores the need for strengthening aspects of the IMCI Programme aimed at promoting breastfeeding and immunization of children as stipulated in the Ministry of Health guidelines which are also in line with those provided by the World Health Organization (WHO) and the United Programme on HIV/AIDS (UNAIDS). Further research is also necessary to explain the mechanism and key proximate determinants through which breastfeeding and immunization act to strongly influence childhood mortality in Kenya.

Outpatient treatment of children with severe pneumonia with oral amoxicillin in four countries: the MASS study

A recent randomized clinical trial demonstrated home-based treatment of WHO-defined severe pneumonia with oral amoxicillin was equivalent to hospital-based therapy and parenteral antibiotics. We aimed to determine whether this finding is generalizable across four countries. Multicentre observational study in Bangladesh, Egypt, Ghana and Vietnam between November 2005 and May 2008. Children aged 3-59 months with WHO-defined severe pneumonia were enrolled at participating health centres and managed at home with oral amoxicillin (80-90 mg/kg per day) for 5 days. Children were followed up at home on days 1, 2, 3 and 6 and at a facility on day 14 to look for cumulative treatment failure through day 6 and relapse between days 6 and 14. Of 6582 children screened, 873 were included, of whom 823 had an outcome ascertained. There was substantial variation in presenting characteristics by site. Bangladesh and Ghana had fever (97%) as a more common symptom than Egypt (74%) and Vietnam (66%), while in Vietnam, audible wheeze was more common (49%) than at other sites (range 2-16%). Treatment failure by day 6 was 9.2% (95% CI: 7.3-11.2%) across all sites, varying from 6.4% (95% CI: 3.1-9.8%) in Ghana to 13.2% (95% CI: 8.4-18.0%) in Vietnam; 2.7% (95% CI: 1.5-3.9%) of the 733 children well on day 6 relapsed by day 14. The most common causes of treatment failure were persistence of lower chest wall indrawing (LCI) at day 6 (3.8%; 95% CI: 2.6-5.2%), abnormally sleepy or difficult to wake (1.3%; 95% CI: 0.7-2.3%) and central cyanosis (1.3%; 95% CI: 0.7-2.3%). All children survived and only one adverse drug reaction occurred. Treatment failure was more frequent in young infants and those presenting with rapid respiratory rates. Clinical treatment failure and adverse event rates among children with severe pneumonia treated at home with oral amoxicillin did not substantially differ across geographic areas. Thus, home-based therapy of severe pneumonia can be applied to a wide variety of settings.

Impact of a community-based integrated management of childhood illnesses (IMCI) programme in Gegharkunik, Armenia

Maternal and child health status in the Martuni region of Gegharkunik marz, Armenia, precipitously declined following Armenia's independence in 1991. In response, the American Red Cross (ARC) and the Armenian Red Cross Society (ARCS) implemented the WHO community-level Integrated Management of Childhood Illnesses (IMCI) strategy, complementing recent clinical IMCI training in the region in which 387 community health volunteers from 16 villages were trained as peer educators, and approximately 5000 caretakers of children under age 5 were counselled on key nutrition and health practices. A pre-post independent sample design was used to assess the programme's impact. The evaluation instrument collected respondent demographic characteristics and knowledge, attitudes and practices consistent with 10 health indicators typical of child survival interventions. At baseline and at follow-up, 300 mothers were interviewed using a stratified simple random sampling of households with at least one child less than age 2. The assessment confirmed the population's poor health status and limited knowledge and application of recommended child care practices. The campaign reached its target: at follow-up, 67% had seen media messages within the past month, 82% had received the IMCI informational booklet, and 30% had seen other materials. Evidence of the success of the programme included the following: exclusive breastfeeding increased 31.4%, maternal knowledge of child illness signs increased 30%, knowledge of HIV increased 28.5%, and physician attended deliveries increased 15%. This evaluation documented the significant and substantial impact of the community IMCI programme on both knowledge and practice in rural areas of Armenia. Consideration should be given to continuing and expanding this project as a complement to health sector development activities in this region.

“Care for Development” Intervention in Rural China: A Prospective Follow-up Study

The aim of this study was to test the efficacy and appropriateness of the World Health Organization's Care for Development (CFD) counseling materials, which form part of the Integrated Management of Childhood Illness (IMCI) strategy. The CFD materials are based on the Mother's Card, which contained age-specific messages on how caregivers can better play and communicate with a child. We enrolled 100 families with a child of younger than 2 years of age from seven randomly selected villages in an impoverished rural county in Anhui Province, China. Two counseling sessions, using the CFD Mother's Card, were provided to 50 families randomly selected from among the study participants. All children were assessed with Gesell Developmental Schedules before counseling and after 6 months. A questionnaire on family situation and knowledge, attitudes, and practices regarding child development was also administered at the start and conclusion of the study. At baseline assessment, both control and intervention groups were equal, with average developmental scores less than the national norms. Children in families who received counseling had significantly higher development quotient scores in cognitive, social, and linguistic domains. Questionnaire data on child rearing suggested that responsive and rich interactions and consistent caregivers correlated with higher scores. The CFD Mother's Card was found to be feasible and helpful in those families who received counseling. There is urgent need for further work on promotion of child development in rural China. The World Health Organization's CFD approach and Mother's Card is feasible and effective and should be expanded in use, especially within the national IMCI program.

Impact of IMCI training and language used by provider on quality of counseling provided to parents of sick children in Bougouni District, Mali

This study evaluates the impact of the Integrated Management Of Childhood Illness (IMCI) training on quality of counseling provided to caregivers about administration of antimalarials to their children. Ten community health centers in southern Mali were randomized to either training or comparison arms of the study, and health providers’ consultations with caregivers were observed. Out of a 10-point counseling scale (Cronbach’s α =0.77), IMCI-trained providers completed an average of 1.47 (95% CI, −0.25, 3.2) more tasks than did providers who had not received IMCI training in a linear regression analysis that accounted for intra-provider correlations. Drug consultations done in both French and the local language, Bambara, had higher scores than those conducted exclusively in Bambara. The effect of providers receiving IMCI training was more pronounced in bilingual consultations, with an average increase of 2.49 (95% CI, 0.76, 4.22) in IMCI, bilingual consultations, and average increase of 0.87 (95% CI, −0.95, 2.69) in IMCI monolingual (Bambara) consultations as compared to non-IMCI-trained providers in monolingual consultations. IMCI training showed a non-significant trend overall in improving drug counseling provided to caregivers, with significant improvements in bilingual consultations. The IMCI program in Mali should consider strategies such as role-playing of counseling in Bambara or other local languages during training to improve patient–provider communication. Similar problems related to counseling by health workers in local languages are likely to be present throughout Africa, and warrant further study.