Integrated Management Of Childhood Illness Training Research Articles

Integrated management of childhood illness in Rwanda: Impact of mentorship on the quality of care in Nyanza and Huye districts

AbstractBackgroundIn Rwanda, health posts (HPs) are intermediary primary care facilities that provide comprehensive primary care services to communities and are located at a reasonable walking distance from people's homes. We assessed the readiness of HPs for Integrated Management of Childhood Illness (IMCI) services and examined changes in the quality of care for IMCI services between districts that implemented IMCI mentorship program (Nyanza district) and Huye district which it did not.MethodsWe conducted a prospective cohort study to assess whether there was change in the quality of IMCI care provided at 17 Nyanza HPs 1‐year after IMCI mentorship implementation. The readiness of HPs for IMCI was assessed across nine factors, resulting in essential (all factors) and desirable (less than seven factors) composite scores. Unpaired t‐tests were used to measure changes in IMCI quality.ResultsThe HPs with IMCI mentorship had an increase in mean desirable (0.7–0.89) and essential (0.61–0.78) composite scores compared to non‐mentored HPs in Huye. The nurses who received mentorship program had improved scores in factors like IMCI training, service package availability, register availability, supportive supervision, and basic equipment availability. Quality improvements in IMCI assessments were observed in vital sign registration, danger sign detection, cough identification, malnutrition screening, and tuberculosis sign identification in the mentored HPs.ConclusionMentorship of nurses in HPs holds promise for enhancing facility readiness and IMCI service quality. Before expanding clinical mentorship, identified gaps such as staffing, supply chains, and health financing need to be addressed.

Implementation of distance learning IMCI training in rural districts of Tanzania

BackgroundThe standard face-to-face training for the integrated management of childhood illness (IMCI) continues to be plagued by concerns of low coverage of trainees, the prolonged absence of trainees from the health facility to attend training and the high cost of training. Consequently, the distance learning IMCI training model is increasingly being promoted to address some of these challenges in resource-limited settings. This paper examines participants’ accounts of the paper-based IMCI distance learning training programme in three district councils in Mbeya region, Tanzania.MethodsA cross-sectional qualitative descriptive design was employed as part of an endline evaluation study of the management of possible serious bacterial infection in Busokelo, Kyela and Mbarali district councils of Mbeya Region in Tanzania. Key informant interviews were conducted with purposefully selected policymakers, partners, programme managers and healthcare workers, including beneficiaries and training facilitators.ResultsAbout 60 key informant interviews were conducted, of which 53% of participants were healthcare workers, including nurses, clinicians and pharmacists, and 22% were healthcare administrators, including district medical officers, reproductive and child health coordinators and programme officers. The findings indicate that the distance learning IMCI training model (DIMCI) was designed to address concerns about the standard IMCI model by enhancing efficiency, increasing outputs and reducing training costs. DIMCI included a mix of brief face-to-face orientation sessions, several weeks of self-directed learning, group discussions and brief face-to-face review sessions with facilitators. The DIMCI course covered topics related to management of sick newborns, referral decisions and reporting with nurses and clinicians as the main beneficiaries of the training. The problems with DIMCI included technological challenges related to limited access to proper learning technology (e.g., computers) and unfriendly learning materials. Personal challenges included work-study-family demands, and design and coordination challenges, including low financial incentives, which contributed to participants defaulting, and limited mentorship and follow-up due to limited funding and transport.ConclusionDIMCI was implemented successfully in rural Tanzania. It facilitated the training of many healthcare workers at low cost and resulted in improved knowledge, competence and confidence among healthcare workers in managing sick newborns. However, technological, personal, and design and coordination challenges continue to face learners in rural areas; these will need to be addressed to maximize the success of DIMCI.

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.

Evaluation of Training Course on “Integrated Management of Neonatal & Childhood Illness” (IMNCI) Using Kirkpatrick Model at Level-2

Introduction: Integrated Management of Childhood Illness (IMNCI), taught by a 6-day training course, is an important initiative to decrease childhood mortality. Level 2 of the Kirkpatrick model entails the assessment of the learning achieved by training activity.Objective: To assess improvement in the knowledge of IMNCI content among the participants of the 6-day IMNCI training program.Methods: After taking approval from IRB, this one-group pre-test-post-test study was carried out in the Paediatrics Medicine Department, King Edward Medical University / Mayo Hospital Lahore over 3 months. By non-probability consecutive sampling, all 77 participants of three 6-day courses (with no previous formal training of IMNCI) were included in the study. To assess any improvement in the knowledge (Kirkpatrick Model Level 2), each participant filled a pre-test and a similar post-test after the training.Data was analyzed by SPSS software. As the data was not normally distributed, the Wilcoxon test was applied to compare the overall median scores of pre-test and post-test. Kruskal-Wallis Test was applied for the comparison of the median scores of pre-test and post-test scores of each professional group. While Mann-Whitney U-test was applied for pairwise comparison of the pre-test and post-test scores between different pairs of professional groups.Results: Of the 77 participants, there were 35 doctors, 20 nurses, 20 Lady Health Visitors, and 2 midwives. The overall median score was 3 (IQR 3) of the pre-test and 8 (IQR 2) for the post-test (p-value < 0.001). Except for the midwives, there was a statistically significant improvement in the median score of each group. Item-analysis of the questions showed that compared to the pre-test, the proportion of correct answers in the post-test showed statistically significant improvement for all the 10 questions. Pairwise comparison of the median pre-test and post-test scores between different professional groups did not show statistical significance except for the doctor-nurse pair.Conclusion: IMNCI training program significantly increased the knowledge of health care providers with no statistical difference between the post-test scores of doctors, LHVs, and midwives.
 KEYWORDS: IMNCI, Training program, Kirkpatrick Model, Childhood mortality, Knowledge evaluation

Impact of Integrated Management of Childhood Illness (IMCI) Training on Case Identification and Management Skills Among Undergraduate Medical Students in a Developing Country: A Case-control Study

Background: In most developing countries, undergraduate medical students rely upon books published by foreign publications of developed countries. These books often fail to include World Health Organization (WHO) recommended guidelines, which are vital for the national health mission of developing countries. As a result, medical students who are “future doctors” continue to lack the necessary skills when they graduate from medical schools and start working in their countries. Objectives: The aim of this study was to quantify the impact of the inclusion of the WHO-recommended integrated management of childhood illness (IMCI) guideline in the curriculum of undergraduate students. Methods: This case-control study was done on a group of 72 undergraduate medical students in the case (trained) group who underwent 12 days of IMCI training and 92 undergraduate students in control (untrained) group who did not receive IMCI training. An evaluation test, which included clinical case scenarios, was conducted to assess the performance of participants from both trained and untrained groups. Results: Participants of the trained group scored significantly higher compared with the participants of the untrained group in the identification and management of major childhood illnesses (P < 0.05). No significant difference was found between trained and untrained groups in the assessment of the immunization status of children. In the trained group, a strong positive correlation (r = 0.87) existed between the attendance percentage of participants during the training session and marks scored in the evaluation (P < 0.001). Conclusions: Our study suggests that the community-oriented WHO recommended IMCI training significantly improves disease identification and case management skills of undergraduate medical students. In developing countries, there is an urgent need for updating medical pedagogy and curriculum, which include WHO guidelines in order to meet current health challenges.

The impact of pulse oximetry and Integrated Management of Childhood Illness (IMCI) training on antibiotic prescribing practices in rural Malawi: A mixed-methods study.

The misdiagnosis of non-malarial fever in sub-Saharan Africa has contributed to the significant burden of pediatric pneumonia and the inappropriate use of antibiotics in this region. This study aims to assess the impact of 1) portable pulse oximeters and 2) Integrated Management of Childhood Illness (IMCI) continued education training on the diagnosis and treatment of non-malarial fever amongst pediatric patients being treated by the Global AIDS Interfaith Alliance (GAIA) in rural Malawi. This study involved a logbook review to compare treatment patterns between five GAIA mobile clinics in Mulanje, Malawi during April-June 2019. An intervention study design was employed with four study groups: 1) 2016 control, 2) 2019 control, 3) IMCI-only, and 4) IMCI and pulse oximeter. A total of 3,504 patient logbook records were included based on these inclusion criteria: age under five years, febrile, malaria-negative, and treated during the dry season. A qualitative questionnaire was distributed to the participating GAIA providers. Fisher's Exact Testing and odds ratios were calculated to compare the prescriptive practices between each study group and reported with 95% confidence intervals. The pre- and post-exam scores for the providers who participated in the IMCI training showed an increase in content knowledge and understanding (p<0.001). The antibiotic prescription rates in each study group were 75% (2016 control), 85% (2019 control), 84% (IMCI only), and 42% (IMCI + pulse oximeter) (p<0.001). An increase in pneumonia diagnoses was detected for patients who received pulse oximeter evaluation with an oxygen saturation <95% (p<0.001). No significant changes in antibiotic prescribing practices were detected in the IMCI-only group (p>0.001). However, provider responses to the qualitative questionnaires indicated alternative benefits of the training including improved illness classification and increased provider confidence. Clinics that implemented both the IMCI course and pulse oximeters exhibited a significant decrease in antibiotic prescription rates, thus highlighting the potential of this tool in combatting antibiotic overconsumption in low-resource settings. Enhanced detection of hypoxia in pediatric patients was regarded by clinicians as helpful for identifying pneumonia cases. GAIA staff appreciated the IMCI continued education training, however it did not appear to significantly impact antibiotic prescription rates and/or pneumonia diagnosis.

'Everybody in Nigeria is a doctor…': a qualitative study of stakeholder perspectives on lay diagnosis of malaria and pneumonia in Nigeria.

Lay diagnosis is a widely used diagnostic approach for home management of common illnesses in Nigeria. This study aimed to explore the perspectives of caregivers and healthcare professionals on lay diagnosis of childhood malaria and pneumonia. Aligned to this, the study sought to explore the feasibility of training caregivers in the Integrated Management of Childhood Illness (IMCI) guidelines for improved recognition and treatment of these diseases. A qualitative study using individual face-to-face semi-structured interviews was conducted in Benin City, Nigeria. Participants included 13 caregivers with children under 5 years and 17 healthcare professionals (HPs). An inductive approach to thematic analysis was used to generate themes and analyses. Caregivers relied on lay diagnosis but recognised its limitations. The perceived severity of malaria and pneumonia significantly influenced caregivers' preference for reliance on lay diagnosis practices, health-seeking behaviour and willingness to undertake training in IMCI guidelines for home management of diseases. Safety and potential unintended misuse of medications were recognised by caregivers and HPs as the main challenges. The high level of acceptance among caregivers to receive IMCI training could help improve effective management of childhood malaria and pneumonia at the community level through early recognition and prompt treatment.

Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria.

Case fatality rates for childhood pneumonia in Nigeria remain high. There is a clear need for improved case management of pneumonia, through the sustainable implementation of the Integrated Management of Childhood Illnesses (IMCI) diagnostic and treatment algorithms. We explored barriers and opportunities for improved case management of childhood pneumonia in Lagos and Jigawa states, Nigeria. A mixed-method analysis was conducted to assess the current health system capacity to deliver quality care. This was done through audits of 16 facilities in Jigawa and 14 facilities in Lagos, questionnaires (n = 164) and 13 focus group discussions with providers. Field observations provided context for data analysis and triangulation. There were more private providers in Lagos (4/8 secondary facilities) and more government providers in Jigawa (4/8 primary, 3/3 secondary, and 1/1 tertiary facilities). Oxygen and pulse oximeters were available in two of three in Jigawa and six of eight in Lagos of the sampled secondary care facilities. None of the eight primary facilities surveyed in Jigawa had oxygen or pulse oximetry available while in Lagos two of three primary facilities had oxygen and one of three had pulse oximeters. Other IMCI and emergency equipment were also lacking including respiratory rate timers, particularly in Jigawa state. Health care providers scored poorly on knowledge of IMCI, though previous IMCI training was associated with better knowledge. Key enabling factors in delivering pediatric care highlighted by health care providers included accountability procedures and feedback loops, the provision of free medication for children, and philanthropic acts. Common barriers to provide care included the burden of out-of-pocket payments, challenges in effective communication with caregivers, delayed presentation, and lack of clear diagnosis, and case management guidelines. There is an urgent need to improve how the prevention and treatment of pediatric pneumonia is directed in both Lagos and Jigawa. Priority areas for reducing pediatric pneumonia burden are training and mentoring of health care providers, community health education, and introduction of oximeters and oxygen supply.

Effects of Training Health Workers in Integrated Management of Childhood Illness on Quality of Care for Under-5 Children in Primary Healthcare Facilities in Afghanistan.

Background: Training courses in integrated management of childhood illness (IMCI) have been conducted for health workers for nearly one and half decades in Afghanistan. The objective of the training courses is to improve quality of care in terms of health workers communication skills and clinical performance when they provide health services for under-5 children in public healthcare facilities. This paper presents our findings on the effects of IMCI training courses on quality of care in public primary healthcare facilities in Afghanistan. Methods: We used a cross-sectional post-intervention design with regression-adjusted difference-in-differences (DiD) analysis, and included 2 groups of health workers (treatment and control). The treatment group were those who have received training in IMCI recently (in the last 12 months), and the control group were those who have never received training in IMCI. The assessment method was direct observation of health workers during patient-provider interaction. We used data, collected over a period of 3 years (2015–2017) from primary healthcare facilities, and investigated training effects on quality of care. The outcome variables were 4 indices of quality care related to history taking, information sharing, counseling/medical advice, and physical examination. Each index was formed as a composite score, composed of several inter-related tasks of quality of care carried out by health workers during patient-provider interaction for under-5 children. Results: Data were collected from 733 primary healthcare facilities with 5818 patients. Quality of care was assessed at the level of patient-provider interaction. Findings from the regression-adjusted DiD multivariate analysis showed significant effects of IMCI training on 2 indices of quality care in 2016, and on 4 indices of quality care in 2017. In 2016 two indices of quality care showed improvement. There was an increase of 8.1% in counseling/medical advice index, and 8.7% in physical examination index. In 2017, there was an increase of 5.7% in history taking index, 8.0% in information sharing index, 10.9% in counseling/medical advice index, and 17.2% in physical examination index. Conclusion: Conducting regular IMCI training courses for health workers can improve quality of care for under-5 children in primary healthcare facilities in Afghanistan. Findings from our study have the potential to influence policy and strategic decisions on IMCI programs in developing countries.

Knowledge acquisition and retention following Saving Children’s Lives course for healthcare providers in Botswana: a longitudinal cohort study

ObjectivesMillions of children die every year from serious childhood illnesses. Most deaths are avertable with access to quality care. Saving Children’s Lives (SCL) includes an abbreviated high-intensity training (SCL-aHIT) for...

The Effectiveness of IMCI (Integrated Management of Childhood Illness) Mini Training in Improving Health Workers’ Skills in Primary Health Centers in Bantul

ABSTRACTBackground: At the Community and Primary Health Care Center in Bantul, the number of paramedics receiving Integrated Management of Childhood Illness (IMCI) training is very limited and not evenly distributed. With the low number of IMCI trained officers, this affects the skill of the officers in conducting the IMCI. Fewer skills affect the handling of sick children including the recognition of general danger signs, classification, designing appropriate action, as well as providing treatment and counseling.Objective: This study aimed to know the effectiveness of IMCI Mini Training intervention to improve health workers’ skills in handling sick children with IMCI.Methods: This research was a quasi-experimental study with a non-equivalent pre-post control group design. The sample of this study was a group of health workers who implement IMCI in daily work at 20 Community and Primary Health Care Centers in Bantul. Data were collected by observing 20 health workers in the control group and 20 health workers in IMCI treatment group before and after receiving IMCI Mini Training. Data results were analyzed using univariate, bivariate and multivariate statistical tests.Results: Using t-test analysis the mean value of health worker’s pretest and posttest skill scores in implementing IMCI in control group showed no significant difference (p=0.857) while in the treatment group, the mean value of pretest and posttest score showed a significant difference (p=0.000). In the treatment group, the improvement of sign recognition skills was significant (p=0.000) compared with the classification (p=0.148), treatment (p=0.009), communication and counseling (p=0.005). Multivariate analysis of linear regression showed that IMCI Mini Training was significant in improving the skill of health workers (p=0.000) compared with variables: age (p=0.970), duty (p=0.425), IMCI training history (p=0.686), category of Community and Primary Health Care Center (p=0.409) and education (p= 0.474). IMCI Mini Training improved significantly the sign recognition skills (p=0.000), classification (p=0.001) as well as communication and counseling (p=0.011) but was not significant in treatment skill (p=0.093). IMCI Mini Training can be done in a shorter time and more interactive method by using ICATT.Conclusion: This study showed that IMCI Mini Training increased health workers’ skills in IMCI implementation with the advantages of shorter course time, lower cost, and more interactive methods. The IMCI skills were enhanced by the provision of IMCI Mini Training which includes skills in the recognition of common signs, classifications as well as providing appropriate communication and counseling.

Feasibility of engaging "Village Doctors" in the Community-based Integrated Management of Childhood Illness (C-IMCI): experience from rural Bangladesh.

BackgroundInformal health care providers particularly “village doctors” are the first point of care for under-five childhood illnesses in rural Bangladesh. We engaged village doctors as part of the Multi-Country Evaluation (MCE) of Integrated Management of Childhood Illness (IMCI) and assessed their management of sick under-five children before and after a modified IMCI training, supplemented with ongoing monitoring and supportive supervision.MethodsIn 2003-2004, 144 village doctors across 131 IMCI intervention villages in Matlab Bangladesh participated in a two-day IMCI training; 135 of which completed pre- and post-training evaluation tests. In 2007, 38 IMCI-trained village doctors completed an end-of-project knowledge retention test. Village doctor prescription practices for sick under-five children were examined through household surveys, and routine monitoring visits. In-depth interviews were done with mothers seeking care from village doctors.ResultsVillage doctors’ knowledge on the assessment and management of childhood illnesses improved significantly after training; knowledge of danger signs of pneumonia and severe pneumonia increased from 39% to 78% (P < 0.0001) and from 17% to 47% (P < 0.0001) respectively. Knowledge on the correct management of severe pneumonia increased from 62% to 84% (P < 0.0001), and diarrhoea management improved from 65% to 82% (P = 0.0005). Village doctors retained this knowledge over three years except for home management of pneumonia. No significant differences were observed in prescribing practices for diarrhoea and pneumonia management between trained and untrained village doctors. Village doctors were accessible to communities; 76% had cell phones; almost all attended home calls, and did not charge consultation fees. Nearly all (91%) received incentives from pharmaceutical representatives.ConclusionsVillage doctors have the capacity to learn and retain knowledge on the appropriate management of under-five illnesses. Training alone did not improve inappropriate antibiotic prescription practices. Intensive monitoring and efforts to target key actors including pharmaceutical companies, which influence village doctors dispensing practices, and implementation of mechanisms to track and regulate these providers are necessary for future engagement in management of under-five childhood illnesses.

Evaluation of distance learning IMCI training program: the case of Tanzania

BackgroundThe standard 11-days IMCI (Integrated Management of Childhood Illness) training course (standard IMCI) has faced barriers such as high cost to scale up. Distance learning IMCI training program was developed as an alternative to the standard IMCI course. This article presents the evaluation results of the implementation of distance learning IMCI training program in Tanzania.MethodsFrom December 2012 to end of June 2015, a total of 4806 health care providers (HCP) were trained on distance learning IMCI from 1427 health facilities {HF) in 68 districts in Tanzania. Clinical assessments were done at the end of each course and on follow up visits of health facilities 4 to 6 weeks after training. The results of those assessments are used to compare performance of health care providers trained in distance learning IMCI with those trained in the standard IMCI course. Statistical analysis is done by comparing proportions of those with appropriate performances using four WHO priority performance indicators as well as cost of conducting the courses. In addition, the perspectives of health care providers, IMCI course facilitators, policy makers and partners were gathered using either focussed group discussions or structured questionnaires.ResultsDistance learning IMCI allowed clusters of training courses to take place in parallel, allowing rapid expansion of IMCI coverage. Health care providers trained in distance learning IMCI performed equally well as those trained in the standard IMCI course in assessing Main Symptoms, treating sick children and counselling caretakers appropriately. They performed better in assessing Danger Signs. Distance learning IMCI gave a 70% reduction in cost of conducting the training courses.ConclusionDistance learning IMCI is an alternative to scaling up IMCI as it provides an effective option with significant cost reduction in conducting training courses.

THE IMPACT OF HOSPITAL BASED INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS TRAINING ON PEDIATRIC NURSE COMPETENCY

Background: Although the WHO strategy integrated management of childhood illness (IMCI) for primary care has been implemented in over 100 countries, there is less global experience with hospital-based IMCI training. Until recently, no training had been done in Indonesia, and globally there has been limited experience of the role of IMCI in rebuilding health systems after complex emergencies.&#x0D; Objective: We aimed to examine the effect of hospital-based IMCI training on pediatric nurse competency and explore the perception of Indonesian doctors, nurse managers and pediatricians about IMCI training and its development in West Aceh, a region that was severely affected by the South-Asian tsunami in December 2004.&#x0D; Methods: This study used stepped wedge design. Training was conducted for 39 nurses’ staff, 13 midwives, 6 head nurses, 5 nurse managers, 5 doctors, 1 pediatrician, and 3 support facilities (nutritionist, pharmacist, laboratory) in Cut Nyak Dien (CND) Hospital in Meulaboh, West Aceh, Indonesia. The IMCI training was developed based on the WHO Pocketbook of Hospital Care for Children. A nurse’s competency questionnaire was used based on the guideline of assessment of the quality of child health services at the first level reference hospitals in districts / municipalities issued by the Ministry of Health in 2007. A linear mixed model was used for data analysis.&#x0D; Results: The hospital based IMCI training improved the competences of nurses pediatric in assessing emergency signs of the sick children, management of cough and difficulty breathing, diarrhea, fever, nutritional problems, supportive care, monitoring, discharge planning and follow-up. The assessment highlighted several problems in adaptation process of material training, training process and implementation in an environment soon after a major disaster.&#x0D; Conclusion: Hospital based IMCI training can be implemented in a setting after major disasters or internal conflict as part of a rebuilding process. The program requires strong management support and the emergency phase to be subsided. Other pre-requisites include the existence of standard operating procedures, adequate physical facilities and support for staff morale and well-being. Improving the quality of pediatric care requires more than just training and clinical guidelines; internal motivation and health worker support are essential.

Impact of educational status of Anganwadi worker on their knowledge and practice regarding integrated management of childhood illness

Background: Today, integrated child development services (ICDS) represents one of the world’s largest programs for early childhood development. Most of the evaluation study concentrated on the nutritional and health status of the beneficiaries of ICDS. Less focus has been shifted over to assess the knowledge and awareness among Anganwadi worker (AWW) regarding various health-care services provided by them, who are actually the main resource person. Objectives: The objectives of this study were to study the educational qualification of AWWs and to assess the knowledge and practice of AWWs regarding various components of implementation of Integrated Management of Childhood Illness (IMNCI) and correlate them with their educational status. Materials and Methods: The present study was a cross-sectional study conducted in five Talukas of Surendranagar district from August 2012 to January 2013. Sample size included all AWWs of five Talukas of Surendranagar district those who had received basic IMNCI training. Of 833 AWWs, 774 were interviewed. Results: The analysis shows that majority of AWWs were educated up to secondary level (49.49%). 57.4% of AWWs were able to correctly answer about the aims of IMNCI training. Study findings suggest that majority of AWWs having good knowledge about breastfeeding and pneumonia, while their practice related to health-care services regarding IMNCI was found satisfactory. Conclusion: As the AWWs are the key person in the program, her education level and knowledge regarding various health-care services play an important role related to her performance. In addition, the refresher training about IMNCI plays a valuable role in improving their performance.

Determinants of Integrated Management of Childhood Illness (IMCI) non-severe pneumonia classification and care in Malawi health facilities: Analysis of a national facility census.

BackgroundResearch shows inadequate Integrated Management of Childhood Illness (IMCI)–pneumonia care in various low–income settings but evidence is largely from small–scale studies with limited evidence of patient–, provider– and facility–levels determinants of IMCI non–severe pneumonia classification and its management.MethodsThe Malawi Service Provision Assessment 2013–2014 included 3149 outpatients aged 2–59 months with completed observations, interviews and re–examinations. Mixed–effects logistic regression models quantified the influence of patient–, provider and facility–level determinants on having IMCI non–severe pneumonia and its management in observed consultations.FindingsAmong 3149 eligible outpatients, 590 (18.7%) had IMCI non–severe pneumonia classification in re–examination. 228 (38.7%) classified cases received first–line antibiotics and 159 (26.9%) received no antibiotics. 18.6% with cough or difficult breathing had 60–second respiratory rates counted during consultations, and conducting this assessment was significantly associated with IMCI training ever received (odds ratio (OR) = 2.37, 95% confidence interval (CI): 1.29–4.31) and negative rapid diagnostic test results (OR = 3.21, 95% CI: 1.45–7.13). Older children had lower odds of assessments than infants (OR = 48–59 months: 0.35, 95% CI: 0.16–0.75). Children presenting with any of the following complaints also had reduced odds of assessment: fever, diarrhea, skin problem or any danger sign. First–line antibiotic treatment for classified cases was significantly associated with high temperatures (OR = 3.26, 95% CI: 1.24–8.55) while older children had reduced odds of first–line treatment compared to infants (OR = 48–59 months: 0.29, 95% CI: 0.10–0.83). RDT–confirmed malaria was a significant predictor of no antibiotic receipt for IMCI non–severe pneumonia (OR = 10.65, 95% CI: 2.39–47.36).ConclusionsIMCI non–severe pneumonia care was sub–optimal in Malawi health facilities in 2013–2014 with inadequate assessments and prescribing practices that must be addressed to reduce this leading cause of mortality. Child’s symptoms and age, malaria diagnosis and provider training were primary influences on assessment and treatment practices. Current evidence could be used to better target IMCI training and support to improve pneumonia care for sick children in Malawi facilities.

Are children presenting with non-IMCI complaints at greater risk for suboptimal screening? An analysis of outpatient visits in Afghanistan.

To determine if children presenting without complaints related to the Integrated Management of Childhood Illness (IMCI) are at greater risk for suboptimal screening for IMCI conditions. Cross-sectional study. Thirty-three provinces in Afghanistan. Observation of 3072 sick child visits selected by systematic random sampling. A 10 point IMCI assessment index. One hundred and thirty-one (4.3%) of the 3072 sick child visits involved no IMCI-related complaints. The mean assessment index for all sick child visits was 4.81 (SD 2.41). Visits involving any IMCI-related complaint were associated with a 1.02 point higher mean assessment index than those without IMCI-related complaints (95% CI, 0.52-1.53; P < 0.001). After adjusting for relevant covariates including patient age, caretaker gender, provider type, provider gender, provider IMCI training status and IMCI guideline availability, we found that children with IMCI-related presenting complaints had a significantly better quality of IMCI screening, than those without IMCI presenting complaints (by 0.75 points; 95% CI, 0.25-1.26; P = 0.003). Our study indicates that children with non-IMCI presenting complaints are at greater risk of suboptimal screening compared to children with IMCI-related presenting complaints. The premise of IMCI is to routinely screen all children for conditions responsible for the major burden of childhood disease in countries like Afghanistan. The study illustrates an important finding that facility and provider capacity needs to be improved, particularly during training, supervision and guideline dissemination to ensure that all children receive routine screening for common IMCI conditions.

A Hypothetical Model to Predict Nursing Students' Perceptions of the Usefulness of Pre-Service Integrated Management of Childhood Illness Training.

This study aimed to test a hypothetical model to predict nursing students' perceptions of the usefulness of pre-service Integrated Management of Childhood Illness (IMCI) training and their intention to apply this training in clinical practice. This study was carried out at the Sur Nursing Institute, Sur, Oman, in May 2015. Using six predefined constructs, a hypothetical structural model was created. The constructs were used as latent variables to highlight their probable impact on intention to apply IMCI-related knowledge and skills in practice. A structured validated questionnaire was subsequently developed to assess the perceptions of nursing students. Factor loadings and calculated variances were examined to ensure convergent validity. Cronbach's alpha was used to calculate internal consistency reliability. Factor loadings for each item in the model were above 0.70. All of the constructs had Cronbach's alpha values over 0.700, except for enhanced assessment skills (Cronbach's alpha: 0.694). The variance extracted value was 0.815 for perceived usefulness, 0.800 for enhanced assessment skills, 0.687 for enhanced knowledge, attitudes and skills, 0.697 for enhanced confidence, 0.674 for enhanced counselling skills and 0.805 for future intention to use IMCI in a clinical setting. Overall, the results support the hypothetical model and indicate that nursing students perceive IMCI training to be beneficial and intend to apply IMCI-related knowledge and skills in clinical practice.

Effect of Integrated Management of Childhood Illness Training on Medical Student’s Knowledge and Clinical Skills

Background:Child health improvement is one of the most important indexes in health programs among all countries. One of the eight millennium development goals for 2015 is reduction of child mortality. Based on WHO recommendation Integrated Management of Childhood Illness (IMCI) is one of the most effective strategies to reduce under five mortality rates. In this study, we tried to compare knowledge and clinical skills about most common childhood illnesses among medical students after IMCI training with control group. Methods: We performed a control trial on two medical intern student groups who were training in pediatric department. Our study was done in Zahedan University of Medical sciences in 2014.We evaluated 18 students in first group (control) and 19 students in second group (intervention). Control group was trained based on routine program education and intervention group educated both routine program and IMCI guideline. Results: We observed significant differences in knowledge score between control and intervention group (P<0.001). Also skill score about management of danger signs in intervention group was significantly higher than control group (P<0.001). Conclusions:IMCI training can be a logical way to improve education quality in pediatric department. Medical students can improve their knowledge and skills effectively through this training.

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.