Integrated Management Of Childhood Illness Strategy Research Articles

The Implementation of Integrated Management of Childhood Illness (IMCI) in Sick Children from 2 Months up to 5 Years Age Old with Diarrhea in Community Health Center

Integrated Management of Childhood Illnesses (IMCI) is a program that focuses on the main childhood diseases that occur in children under five years of age with a focus on pneumonia (acute respiratory infection), diarrhea, malaria, measles, dengue hemorrhagic fever (DHF), ear and malnutrition. Diarrhea is a global health problem that causes high morbidity and mortality in developing countries due to poor environmental sanitation and hygiene, inadequate water supply, poverty and limited access to education. IMCI is a strategy that focuses on child as a whole, not on a single disease or condition, but on a combination of illnesses that need to be treated in an integrated manner at home and in primary health care facilities. Based on the Becora Community Health Center report that cases handled using the IMCI strategy totaled 2,204 cases in 2021, 4,273 cases in 2022 and 3,160 cases, from January to June 2023. Diarrhea cases ranked first, namely 584 cases in 2021, and in 2022 experienced an increase to 758 cases and until June 2023 cases of diarrhea reached 416 cases. The purpose of this residency is to know the management of cases of diarrhea by using IMCI strategies at the Becora Health Center, Dili, Timor Leste. Using descriptive studies because they only wanted to know the frequency distribution of cases handled with IMCI and specifically wanted to observe the management procedures in cases with diarrhea. Based on the results residence from 17-29 July 2023, 598 cases were not handled according to the IMCI strategy, of which 10.37% (n=62) cases had diarrhea and 0.5% (n=3) dysentery cases. In accordance with the results of observations that the IMCI management procedures are not in accordance with ministry standards or policies issued by the Ministry of Health Timor Leste. During residence it appears that health professionals conducting consultations are more directed to using general consultations than using the IMCI strategy.

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.

Integrated management of neonatal and childhood illness strategy in Zimbabwe: An evaluation.

More than five million children under the age of five die each year worldwide, primarily from preventable and treatable causes. In response, the World Health Organization's Integrated Management of Childhood Illnesses (IMNCI) strategy has been adopted in more than 95 low- and middle-income countries, 41 of them from Africa. Despite IMNCI's widespread implementation, evidence on its impact on child mortality and institutional deliveries is limited. This study examined the effect of IMNCI strategy in the context of Zimbabwe, where neonatal and infant mortality rates are among the highest in the world. We used binary logistic regression to analyze cross-sectional data from the 2015 Zimbabwe Demographic and Health Survey. Zimbabwe implemented the IMNCI strategy in 2012. Our empirical strategy involved comparing neonatal and infant mortality and institutional deliveries within the same geographic area before and after IMNCI implementation in a nationally representative sample of children born between 2010 and 2015. Exposure to IMNCI was significantly associated with a reduction in neonatal mortality (adjusted odds ratio (95% CI): 0.70 (0.50, 0.98)) and infant mortality (adjusted odds ratio (95% CI): 0.69 (0.54, 0.91)). The strategy also helped increase institutional deliveries significantly (adjusted odds ratio (95% CI): 1.95 (1.67, 2.28)). Further analyses revealed that these associations were concentrated among educated women and in rural areas.The IMNCI strategy in Zimbabwe seems to be successful in delivering its intended goals. Future programmatic and policy efforts should target women with low education and those residing in urban areas. Furthermore, sustaining the positive impact and achieving the child health-related Sustainable Development Goals will require continued political will in raising domestic financial investments to ensure the sustainability of maternal and child health programs.

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.

Aplicación de prácticas clave: lactancia materna, alimentación complementaria, micronutrientes, desarrollo mental y social de niños menores de 5 años

Objetivo: evaluar la aplicación de la estrategia AIEPI en la promoción de la lactancia materna exclusiva, alimentación complementaria, uso de micronutrientes y prevención de alteraciones en el desarrollo mental y social de los niños menores de 5 años. Materiales y métodos: estudio cuantitativo descriptivo-correlacional; se utilizó una muestra de 323 padres de familia y/o cuidadores. Resultados: la lactancia materna exclusiva se proporcionó en un 52% y en la alimentación complementaria los alimentos de elección fueron los cereales 77,1%, tubérculos 71,8%, frutas 40% y verduras 43%. Administran cantidades suficientes de micronutrientes 82,4%. El 92,6% brindan caricias y un 83,9% usan el juego como forma de estímulo para sus hijos. Hubo correlación entre la edad del cuidador y la lactancia materna exclusiva (p valor 0,019), de igual forma se correlaciono la edad del cuidador (mayores de 23 años) y la inclusión de la alimentación complementaria como cereales (p valor 0,000) /NOTA: “p” quiere decir muchas. Conclusión: se evidencia que las prácticas relacionadas con el componente uno de la estrategia AIEPI relacionada a la lactancia materna, alimentación complementaria, micronutrientes, desarrollo mental y social de niños menores de 5 años, son aplicadas en un sector de Cartagena; sin embargo, existes resultados que constituyen porcentajes significativos en el aumento del riesgo de aparición de enfermedades como la diarrea e infección respiratoria aguda.

Feasibility of implementing Integrated Management of Childhood Illnesses through Mobile Technology

Abstract Background The Integrated Management of Childhood Illnesses (IMCI) strategy was launched by WHO and partners in 1995 to reduce child mortality by enhancing frontline health workers' (FHWs) ability to diagnose and manage childhood illnesses, and strengthen overall health systems. However, although IMCI is associated with decreased child mortality, numerous studies have shown its impact has been limited due to persistent barriers to implementation. Methods We developed a digitized version of IMCI (eIMCI) using Android technology to overcome implementation problems, including poor protocol compliance, lengthy trainings, paper-based data collection, and gaps in the referral system. The feasibility and efficacy of eIMCI was assessed through a mixed-methods pilot study encompassing baseline and end-line surveys, interviews, and Focus Group Discussions, in a low-resource rural district of Punjab, Pakistan. During the 8 weeks of deployment, a total of 1,978 children were enrolled in the eIMCI application by 10 participating FHWs, and 47 electronic referrals were generated. Results Preliminary outcomes showed reduced disease occurrence (for example, diarrhea decreased from 48% at baseline to 29% at endline), increased adherence to IMCI protocol, and strengthened health system linkages (facility referrals increased from 5% at baseline to 45% at endline). FHWs reported enhanced performance, as well as an improved community response to their services. Discussion Indicating the feasibility and efficacy of eIMCI deployment in a low-resource setting, evidence from the pilot demonstrates the benefit of digitizing the IMCI protocol. eIMCI is a digital health solution with the potential to significantly reduce child mortality and improve service delivery and performance of FHWs. Key messages eIMCI is a feasible solution for the implementation of IMCI strategy in developing countries and demonstrates increased compliance and enhanced performance by the frontline health workers. Implementation of eIMCI can result in a significant reduction in child morbidity and mortality via timely referrals of patients and reduced disease occurrence.

Challenges facing professional nurses implementing the Integrated Management of Childhood Illness programme in rural primary health care clinics, Limpopo Province, South Africa.

BackgroundUnder-five mortality and morbidity could be reduced through increased implementation of the Integrated Management of Childhood Illness (IMCI) strategy. The aim of the study was to determine challenges facing IMCI-trained professional nurses on implementing this strategy when managing children less than 5 years of age.MethodsA quantitative descriptive survey method was used. The target populations were IMCI-trained professional nurses with the sample of 208 respondents. Data were collected through self-report questionnaires and analysed using statistical analysis system software.ResultsThe implementation of the IMCI strategy by IMCI-trained professional nurses in Vhembe primary health care (PHC) clinics continues to face challenges, making it difficult for professional nurses to follow guidelines. These challenges range from staff barriers, management barriers, poor management process and poor infrastructure. All these challenges lead to poor-quality under-five patient care.ConclusionRegardless of the IMCI strategy being implemented since its inception in 1999, the under-five mortality remains not reduced. This is related to the identified challenges facing the IMCI-trained professional nurses implementing the strategy.

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

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).

Evaluate the Implementation of Integrated Management of Childhood Illness regarding Nutritional Care in Egypt

Background: The Integrated Management of Childhood Illnesses (IMCI) is a cost-effective strategy that advocates utilization of evidence-based protocol in the management of common childhood illness. WHO estimated that 56% of childhood deaths worldwide are attributable to the effects of under nutrition. Aim: The study aimed to evaluate the implementation of IMCI strategy regarding nutritional care of under five years children in Mansoura district. Research Design: The study adopted a descriptive cross-sectional research design. Subjects and sampling: The total number of the study subjects was 501 (36 healthcare professionals (HCPs), 456 caregivers and their children under five years and 9 mangers of healthcare settings). Setting: This study was carried out in nine primary health care settings affiliated to Mansoura District, Dakhalia governorate, Egypt. Study tools: three tools were used for data collection. 1-Healthcare professionals' occupational and educational qualifications data assessment sheet. 2-Observation checklist of case management implementation. 3- Mangers' feedback self-administrated questionnaire. Results: current results showed that (23.8%) of newborn suffered from feeding problems and 64.3% of their caregivers informed when to back immediately to health center. The treatment of feeding and underweight for age problems for children from 7 days to two months constitutes(53.3%). Nearly half (48.2%) of total children were observed by HCPs showed poor level of adherence to case management compared to 18.6% of them showed good level of adherence. All mangers reported lack of motivation and insufficient number of trained health care workers among the constraints of IMCI implementation. Conclusion: the level of adherence of HCPs regarding children's case management of nutritional status was poor for nearly half of cases compared to less than one fifth showed good level of adherence. Recommendations: the study recommended that IMCI in-service training should be adequately addressed the health care providers with knowledge about the importance of nutrition in health.

Implementation of Integrated Management of Childhood Illness Strategy's in Al Hadbaa Primary Health Care Center in Mosul City

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.

Utilização da Estratégia de Atenção Integrada às Doenças Prevalentes na Infância

Estudo que objetivou descrever a utilização da Estratégia de Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) por médicos e enfermeiros que atuavam na Estratégia Saúde da Família em capital do centro-oeste brasileiro. Estudo descritivo desenvolvido com 50 médicos e 51 enfermeiros que trabalhavam em unidades de saúde da família. Os dados foram coletados utilizando-se um questionário. A maioria dos pesquisados era do sexo feminino (69,3%), com três a cinco anos de formados (32,7%), sendo que 50,5% demonstrou conhecer o conteúdo sobre a estratégia, aprendido durante a graduação. Cerca de 44,6% dos profissionais utiliza parcialmente a estratégia, sendo que o elemento mais usado por eles é a avaliação de crescimento e anemia (25,4%). Os resultados encontrados são preocupantes, pois a não utilização de todos os componentes da AIDPI pode refletir na impossibilidade de detecção de doenças tratáveis na atenção primária, aumentando o número de internações hospitalares evitáveis.

Evaluating the Integrated Management of Childhood Illness counselling skills of professional nurses in the North West Province of South Africa.

BackgroundThe Integrated Management of Childhood Illness (IMCI) strategy provides guidelines for supporting and improving the health system to reduce under-5 children’s mortality rates. This strategy specifically assists professional nurses with the case management of children aged birth–5 years.AimThe purpose of this study was to investigate how professional nurses provided counselling to caregivers of under-5 children based on the IMCI strategy in Primary Health Care facilities of one district in the North West Province of South Africa.SettingPrimary Health Care (PHC) facilities of one district in the North West Province.MethodA quantitative, descriptive and observational design was used. Counselling provided by the professional nurses was observed and a checklist was completed. This IMCI counselling checklist was based on aspects in the counselling section of the Health Facility Survey, formulated according to the IMCI strategy’s requirements.ResultsCounselling that focused on feeding, administration of medication and counselling skills used during the consultation were good. However, counselling of caregivers of children aged 13 months to 5 years could be improved and the caregivers’ health status should also be addressed.ConclusionCounselling provided to caregivers of under-5 children regarding feeding, administering of medication and caregivers’ health status used effective communication skills. However, technicalities of feeding such as lactation and nutritional guidance posed challenges.

Investigation and analysis of the health care seeking behaviour of caregivers of sick children in Xinjiang, China: a cross-sectional study

BackgroundThe Integrated Management of Childhood Illness (IMCI) strategy aims to reduce death, illness, and disability, and to promote improved growth and development among children younger than 5 years, especially through making the best use of the available health-care resources. The IMCI strategy has been introduced in Xinjiang, China, by Save the Children since 2014. The health care seeking behaviour of caregivers of children who are sick is identified as the primary factor affecting the project implementation. We thus aimed to study factors that might influence health care seeking behaviour of caregivers in Xinjiang. MethodsWe did a cross-sectional study in Xinjiang using a socioeconomic questionnaire and semi-structured interview with questions about health care seeking behaviour and its influencing factors in Chinese and Uighur. We recruited caregivers of sick children younger than 5 years from villages in townships of the Moyu County, Xinjiang, as the targeted project sites, using a stratified random cluster sampling method. We excluded caregivers with mental disorders, communicable diseases, and severe organic disease (ie, patients who could not finish the interview). The primary measure was the type of health-care institution that caregivers of sick children chose. We used descriptive statistics and a linear regression analysis. Ethical approval was obtained from the Peking University Health Science Center Ethics Committee. All participants provided written informed consent. FindingsBetween Jan 29, 2018, and April 28, 2018, 945 caregivers were recruited from 69 villages in eight township of the Moyu County. 877 caregivers completed the questionnaires, yielding a response rate of 93%. Although the public village clinics were strongly encouraged by the IMCI strategy, 347 (40%) of 877 caregivers regarded private clinics as their first choice, 299 (34%) chose the township health centres, and only 95 (11%) chose public village clinics. The cost (odds ratio [OR] 2·59, 95% CI 1·74–3·86; p<0·0001), distance (2·19, 1·55–3·10; p=0·0009), and attitudes of the medical staffs (1·46, 1·02–2·07; p=0·037) were considered as the facilitators that promote caregivers to choose the public village clinics, whereas the traditional values on health care seeking behaviour (OR 0·50, 95% CI 0·27–0·91; p=0·023) and inadequate medicines (0·33, 0·19–0·58; p=0·0004) were considered as the hindrances that impede caregivers to choose the public village clinics. InterpretationThe health care seeking behaviour of the caregivers of the children who are sick were not as expected compared with what the IMCI recommended. More attention needs to be given on the issue of the local culture's health care seeking behaviour. Besides enhancing the village doctors' competencies, adequate numbers and types of medicines are very important, which is also the key point of the strategies to promote children's health in the rural areas of Xinjiang and western China. FundingSave the Children (number CTXJ-2018-0148).

Health system factors affecting implementation of integrated management of childhood illness (IMCI): qualitative insights from a South African province.

The Integrated Management of Childhood Illness (IMCI) strategy has been adopted by 102 countries including South Africa, as the preferred primary health care (PHC) delivery strategy for sick children under 5 years. Despite substantial investment to support IMCI in South Africa, its delivery remains sub-optimal, with varied implementation in different settings. There is scarce research globally, and in the local context, examining the effects of health system characteristics on IMCI implementation. This study explored key determinants of IMCI delivery in a South African province, with a specific focus on health system building blocks using a health system dynamics framework. In-depth interviews were conducted with 38 districts, provincial and national respondents involved with IMCI co-ordination and delivery, exploring their involvement in, and perceptions of, IMCI strategy implementation. Identified barriers included poor definition of elements of a service package for children and how IMCI aligned with this, incompetence of trained nurses exacerbated by inappropriate rotation practices, use of inappropriate indicators to track progress, multiple cadres coordinating similar activities with poor role delineation, and fragmented, vertical governance of programmes included within IMCI, such as immunization. Enabling practices in one district included the use of standardized child health records incorporating IMCI activities and stringent practice monitoring through record audits. Using IMCI as a case study, our work highlights critical health system deficiencies affecting service delivery for young children which need to be resolved to reposition IMCI within the broader child 'survive, thrive and transform' agenda. Recommendations for appropriate health system strengthening include the need for redefining IMCI within a broader PHC service package for children, prioritizing post-training supervision and mentoring of practitioners through appropriate duty allocation and rotation policies, strengthening IMCI monitoring with a specific focus on quality of care and building stronger clinical governance through workforce allocation, role delineation and improved accountability.

Prácticas clave y conocimientos maternos de la Estrategia AIEPI en el Ambiente Comunitario

The Integrated Management of Childhood Illness (IMCI) strategy aims to reduce disease and mortality among children under five years of age through the implementation of actions aimed at providing adequate care at the medical, home and community levels. The objective was to identify and classify the reports that have been published regarding the application of key practices and the knowledge that mothers and caregivers have regarding the IMCI strategy in the world. To this end, national and international publications were collected which were written in English or Spanish and registered in databases or information sources such as Scielo, Bireme, Pubmed, Google Scholar and academic theses. The evidence levels of most papers were VII and VIII because they were case, controls and descriptive studies. The studies on maternal knowledge showed the shortcomings of parents and/or caregivers of children under five years of age concerning the actions and strategies that should be applied to appropriately manage prevalent diseases. Regarding key practices, the studies considered in this literature review are consistent in demonstrating their effectiveness in improving the health and welfare conditions among children under five years of age, on whom they are applied. The studies also agree on the importance of advancing educational processes which strengthen the knowledge and application of the key practices as well as the strategy in general, for both communities and healthcare professionals.

A Hypothetical Model to Predict the Potential Impact of Government and Management Support in Implementing Integrated Management of Childhood Illness Practices.

Despite broad adoption and implementation of Integrated Management of Childhood Illness (IMCI) in more than 100 countries, childhood mortality and morbidity rates continue to prevail. This calls for further investigation to identify the factors that prevent actual application of IMCI-recommended clinical practices. This study tests a hypothetical structural model to investigate potential role of government and healthcare policymakers on improving implementation and application of IMCI-recommended practices in clinical setting. The study was carried out at Sur and Ibra Nursing Institutes in Oman, in June 2016. We used six pre-tested and validated constructs for developing a hypothetical structural model. The constructs were used as underlying variables to examine the probable influence of government and policymakers on actual application of IMCI-recommended practices. Data were collected through structured questionnaires, which designed to measure healthcare professionals' perceptions. Each construct was pre-loaded with three sub-constructs. Cronbach's alpha (CA) was used to calculate the internal consistency and reliability. Factor loadings for each item in the model were ≥ 0.700. CA values for all the studied constructs were > 0.600. The average variance extracted values for all the constructs were > 0.500. The findings support the hypothetical structural model and highlights governments could play a significant role in ensuring that IMCI strategy is not only implemented, but also its recommended practices are applied in clinical setting.

Integrated management of childhood illness (IMCI) strategy for children under five.

Integrated management of childhood illness (IMCI) strategy for children under five.

Integrated Management of Childhood Illness strategy implementation in a rural district of Pakistan through the lens of planners and implementers

Objective: Integrated Management of Childhood Illness (IMCI) strategy aims to reduce under-five morbidity and mortality in developing countries. This qualitative study aimed to explore and analyze stakeholders’ perceptions about IMCI implementation process at Primary Health Care facilities in Matiari district, Sindh Province, Pakistan. Methods: This study used qualitative exploratory design. Through purposive sampling technique, eight stakeholders particularly involved in IMCI implementation process at district (n=3) and provincial level (n=5) were recruited for in-depth interviews. Interview data was manually transcribed and analyzed using content analysis. Results: The interviews provided information on factors supporting and constraining IMCI implementation process. Stakeholders’ perception of the significance of the strategy was the single most influential support factor. Constraint factors mainly consist of discrepancies in views toward the lead role in implementation, trained physicians’ lack of willingness to practice IMCI strategy (as perceived by the stakeholders), inadequate logistic support, weak monitoring and supervisory system, lack of awareness about IMCI drugs and supplies, hindrances in the reporting system and corruption in the district health system affecting the practice of IMCI trained physicians. Conclusions: The study showed inadequate health system support for IMCI implementation in the district with major discrepancies in views amongst planners and implementers toward IMCI implementation process. We recommend Provincial Maternal Neonatal and Child Health Program to synchronize the implementation process and provide necessary support to the district in IMCI implementation.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana

BackgroundUnder-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions.DesignA quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data.ResultsThe study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy.ConclusionsThe comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana.

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