Integrated Management Of Childhood Illness Implementation 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.

Electronic Integrated Management of Childhood Illness (eIMCI): a randomized controlled trial to evaluate an electronic clinical decision-making support system for management of sick children in primary health care facilities in South Africa

BackgroundElectronic clinical decision-making support systems (eCDSS) aim to assist clinicians making complex patient management decisions and improve adherence to evidence-based guidelines. Integrated management of Childhood Illness (IMCI) provides guidelines for management of sick children attending primary health care clinics and is widely implemented globally. An electronic version of IMCI (eIMCI) was developed in South Africa.MethodsWe conducted a cluster randomized controlled trial comparing management of sick children with eIMCI to the management when using paper-based IMCI (pIMCI) in one district in KwaZulu-Natal. From 31 clinics in the district, 15 were randomly assigned to intervention (eIMCI) or control (pIMCI) groups. Computers were deployed in eIMCI clinics, and one IMCI trained nurse was randomly selected to participate from each clinic. eIMCI participants received a one-day computer training, and all participants received a similar three-day IMCI update and two mentoring visits. A quantitative survey was conducted among mothers and sick children attending participating clinics to assess the quality of care provided by IMCI practitioners. Sick child assessments by participants in eIMCI and pIMCI groups were compared to assessment by an IMCI expert.ResultsSelf-reported computer skills were poor among all nurse participants. IMCI knowledge was similar in both groups. Among 291 enrolled children: 152 were in the eIMCI group; 139 in the pIMCI group. The mean number of enrolled children was 9.7 per clinic (range 7-12). IMCI implementation was sub-optimal in both eIMCI and pIMCI groups. eIMCI consultations took longer than pIMCI consultations (median duration 28 minutes vs 25 minutes; p = 0.02). eIMCI participants were less likely than pIMCI participants to correctly classify children for presenting symptoms, but were more likely to correctly classify for screening conditions, particularly malnutrition. eIMCI participants were less likely to provide all required medications (124/152; 81.6% vs 126/139; 91.6%, p= 0.026), and more likely to prescribe unnecessary medication (48/152; 31.6% vs 20/139; 14.4%, p = 0.004) compared to pIMCI participants.ConclusionsImplementation of eIMCI failed to improve management of sick children, with poor IMCI implementation in both groups. Further research is needed to understand barriers to comprehensive implementation of both pIMCI and eIMCI. (349)Clinical trials registrationClinicaltrials.gov ID: BFC157/19, August 2019.

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.

Introducing pulse oximetry in routine IMCI services in Bangladesh: A context-driven approach to influence policy and programme through stakeholder engagement.

BackgroundPneumonia is the leading cause of under-five child deaths globally and in Bangladesh. Hypoxaemia or low (<90%) oxygen concentration in the arterial blood is one of the strongest predictors of child mortality from pneumonia and other acute respiratory infections. Since 2014, the World Health Organization recommends using pulse oximetry devices in Integrated Management of Childhood Illness (IMCI) services (outpatient child health services), but it was not routinely used in most health facilities in Bangladesh until 2018. This paper describes the stakeholder engagement process embedded in an implementation research study to influence national policy and programmes to introduce pulse oximetry in routine IMCI services in Bangladesh.MethodsBased on literature review and expert consultations, we developed a conceptual framework, which guided the planning and implementation of a 4-step stakeholder engagement process. Desk review, key informant interviews, consultative workshops and onsite demonstration were the key methods to involve and engage a wide range of stakeholders. In the first step, a comprehensive desk review and key informant interviews were conducted to identify stakeholder organisations and scored them based on their power and interest levels regarding IMCI implementation in Bangladesh. In the second step, two national level, two district level and five sub-district level sensitisation workshops were organised to orient all stakeholder organisations having high power or high interest regarding the importance of using pulse oximetry for pneumonia assessment and classification. In the third step, national and district level high power-high interest stakeholder organisations were involved in developing a joint action plan for introducing pulse oximetry in routine IMCI services. In the fourth step, led by a formal working group under the leadership of the Ministry of Health, we updated the national IMCI implementation package, including all guidelines, training manuals, services registers and referral forms in English and Bangla. Subsequently, we demonstrated its use in real-life settings involving various levels of (national, district and sub-district) stakeholders and worked alongside the government leaders towards carefully resuming activities despite the COVID-19 pandemic.ResultsOur engagement process contributed to the national decision to introduce pulse oximetry in routine child health services and update the national IMCI implementation package demonstrating country ownership, government leadership and multi-partner involvement, which are steppingstones towards scalability and sustainability. However, our experience clearly delineates that stakeholder engagement is a context-driven, time-consuming, resource-intensive, iterative, mercurial process that demands meticulous planning, prioritisation, inclusiveness, and adaptability. It is also influenced by the expertise, experience and positionality of the facilitating organization.ConclusionsOur experience has demonstrated the value and potential of the approach that we adopted for stakeholder engagement. However, the approach needs to be conceptualised coupled with the allocation of adequate resources and time commitment to implement it effectively.

Evaluation of the Implementation of Integrated Management of Childhood Illness in Special Region of Yogyakarta Province, Indonesia

BACKGROUND: Child mortality rate in Indonesia is now fluctuating. The Province of the Special Region of Yogyakarta (DIY) had fluctuated infant mortality rate in the recent years. As a result, guidelines of Integrated Management of Childhood Illness (IMCI) are still required to improve the health of Indonesian children. AIM: This study aimed to explore the implementation of IMCI in DIY Province in terms of input, process, and output components. METHODS: A case study approach with a qualitative method was conducted among implementers of IMCI in the DIY Province. The data were obtained from secondary sources, such as the reports, attendance lists, and focus group discussion video recordings. RESULTS: The results were differentiated by input, process, and output components. Most IMCI implementers have not received special training (input); there were no specific guidelines for sick children during the COVID-19 pandemic (process); and the IMCI implementation target has not been achieved with the percentage below 60–70% (output). CONCLUSION: The implementation of IMCI in Yogyakarta Province is still required to improve the quality of services provided to sick children.

The feasibility and ongoing use of electronic decision support to strengthen the implementation of IMCI in KwaZulu-Natal, South Africa

BackgroundContinued efforts are required to reduce preventable child deaths. User-friendly Integrated Management of Childhood Illness (IMCI) implementation tools and supervision systems are needed to strengthen the quality of child health services in South Africa. A 2018 pilot implementation of electronic IMCI case management algorithms in KwaZulu-Natal demonstrated good uptake and acceptance at primary care clinics. We aimed to investigate whether ongoing electronic IMCI implementation is feasible within the existing Department of Health infrastructure and resources.MethodsIn a mixed methods descriptive study, the electronic IMCI (eIMCI) implementation was extended to 22 health facilities in uMgungundlovu district from November 2019 to February 2021. Training, mentoring, supervision and IT support were provided by a dedicated project team. Programme use was tracked, quarterly assessments of the service delivery platform were undertaken and in-depth interviews were conducted with facility managers.ResultsFrom December 2019 – January 2021, 9 684 eIMCI records were completed across 20 facilities, with a median uptake of 29 records per clinic per month and a mean (range) proportion of child consultations using eIMCI of 15% (1–46%). The local COVID-19-related movement restrictions and epidemic peaks coincided with declines in the monthly eIMCI uptake. Substantial inter- and intra-facility variations in use were observed, with the use being positively associated with the allocation of an eIMCI trained nurse (p < 0.001) and the clinician workload (p = 0.032).ConclusionThe ongoing eIMCI uptake was sporadic and the implementation undermined by barriers such as low post-training deployment of nurses; poor capacity in the DoH for IT support; and COVID-19-related disruptions in service delivery. Scaling eIMCI in South Africa would rely on resolving these challenges.

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.

An Overview of the Knowledge and Motivation of IMCI Staff Regarding the Implementation of IMCI at the Lubuk Buaya Public Health Center, Padang

Introduction: Indonesia is one of the developing countries with a high under-five mortality rate due to the rough handling of Integrated Management of Childhood Illness (IMCI). Diseases that cause death can generally be treated at the hospital level, but it is still difficult at the public health center level. Public Health Centers have implemented (IMCI). Suppose they meet the criteria for implementing/implementing the IMCI approach at least 60% of the number of visits by sick toddlers. This study aimed to describe the knowledge and motivation of IMCI implementers regarding the implementation of IMCI at Lubuk Buaya Public Health Center, Padang, in 2014. Method: This research is descriptive. This research was conducted at the Lubuk Buaya Health Center Padang in May 2014. The population in this study were all IMCI implementers who were actively working at the Lubuk Buaya Public Health Center, Padang, with 37 people. Sampling with total sampling technique and analyzed univariately. Results: From 37 staff implementing IMCI, it was found that 31 (83.8%) staff had implemented IMCI well, 36 (97.3%) staff had high knowledge, and 23 (62.2%) staff had high motivation. Conclusions: This study shows that the knowledge and motivation of IMCI implementers are good in implementing IMCI. It is hoped that every IMCI implementer will further increase knowledge about IMCI and its performance so that all sick toddlers get the best IMCI services to prevent death in these toddlers.

The integrated management of childhood illness (IMCI) and its potential to reduce the misuse of antibiotics.

BackgroundThe Strategy of the Integrated Management of Childhood Illness (IMCI) was introduced in Central Asia and Europe to address the absence of evidence-based guidelines, the misuse of antibiotics, polypharmacy and over-hospitalization of children. A study carried out in 16 countries analysed the status and strengths of as well as the barriers to IMCI implementation and investigated how different health systems affect the problems IMCI aims to address. Here we present findings in relation to IMCI’s effects on the rational use of drugs, particularly the improved rational use of antibiotics in children, the mechanisms through which these were achieved as well as counteracting system factors.Methods220 key informants were interviewed ranging from 5 to 37 per country (median 12). Data was analysed for arising themes and peer-reviewed.ResultsThe implementation of IMCI led to improved prescribing patterns immediately after training of health workers according to key informants. IMCI provides standard treatment guidelines and an algorithmic diagnostic- and treatment-decision-tool for consistent decision-making. Doctors reported feeling empowered by the training to counsel parents and address their expectations and desire for invasive treatments and the 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; and access to drugs without prescriptions.ConclusionsFuture efforts to improve child health outcomes must include: (1) the continued support to improve health worker performance to enable them to adhere to evidence-based treatment guidelines, (2) patient and parent education, (3) improved reimbursement schemes and prescription regulations and their consistent enforcement and (4) the integration of point–of-care tests differentiating between viral and bacterial infection into standards of care. Pre-requisites will be sufficient remuneration of health workers, 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.

Integrated Management of Childhood Illnesses (IMCI): a mixed-methods study on implementation, knowledge and resource availability in Malawi

BackgroundThe introduction of the WHO’s Integrated Management of Childhood Illnesses (IMCI) guidelines in the mid-1990s contributed to global reductions in under-five mortality. However, issues in quality of care have been...

\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.

Improving the Assessment and Classification of Sick Children according to the Integrated Management of Childhood Illness (IMCI) Protocol at Sanja Primary Hospital, Northwest Ethiopia: A Pre-Post Interventional Study.

Background A complete and consistent use of integrated management of childhood illness (IMCI) protocol is a strategic implementation that has been used to promote the accurate assessment and classifications of childhood illnesses, ensures appropriate combined treatment, strengthens the counseling of caregiver, and speeds up the referrals to decrease child mortality and morbidity. However, there is limited evidence about the complete and consistent use of IMCI protocol during the assessment and classifications of childhood illness in Ethiopia. Therefore, this intervention was implemented to improve the assessment and classifications of childhood illness according to the IMCI protocol in Sanja primary hospital, northwest Ethiopia. Methods A pre-post interventional study was used in Sanja primary hospital from January 01 to May 30, 2019. A total of 762 (381 for pre and 381 for postintervention) children from 2 months up to 5 years of age were involved in the study. Data were collected using a structured questionnaire prepared from the IMCI guideline, and a facility checklist was used. A five-month in-service training, weekly supportive supervision, daily morning session, and availing essential drugs and materials were done. Both the descriptive statistics and independent t-test were done. In the independent t-test, a p value of <0.05 and a mean difference with 95% CI were used to declare the significance of the interventions. Results The findings revealed that the overall completeness of the assessment was improved from 37.8 to 79.8% (mean difference: 0.17; 95% CI: 0.10-0.22), consistency of assessment with classification from 47.5 to 76.9% (mean difference: 0.34; 95% CI: 0.27-0.39), classification with treatment from 42.3 to 75.4% (mean difference: 0.35; 95% CI: 0.28-0.47), and classification with follow-up from 32.8 to 73.0% (mean difference: 0.36; 95% CI: 0.29-0.42). Conclusion The intervention has a significant improvement in the assessment and classification of childhood illness according to the IMCI protocol. Therefore, steps must be taken to ensure high quality of training, adequate supervision including the observation of health workers managing sick children during supervisory visits, and a constant supply of essential drugs and job aids for successful implementation of IMCI in the hospital and also to other facilities.

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).

Acceptability and uptake of an electronic decision-making tool to support the implementation of IMCI in primary healthcare facilities in KwaZulu-Natal, South Africa

ABSTRACT Background: Despite progress in reducing child mortality, preventable child deaths remain a challenge in South Africa. Poor implementation of Integrated Management of Childhood Illness (IMCI) guidelines has been well described, and the reported barriers to implementation include a lack of user-friendly implementation tools. Aim: To investigate whether an electronic decision support tool to strengthen IMCI implementation is acceptable to nurses, clinic managers and caregivers at primary care facilities in KwaZulu-Natal, South Africa. Methods: The electronic IMCI (eIMCI) software was tested in 15 health facilities in uMgungundlovu district from May to July 2018. System use was tracked and qualitative data obtained from three user groups. IMCI practitioners participated in questionnaires and focus groups, operational managers in in-depth interviews and caregivers in exit interviews. Results: Thirty-two IMCI practitioners, six operational managers and 30 caregivers were included. Acceptance was high among caregivers and operational managers, albeit less conclusive among IMCI practitioners whose eIMCI uptake indicated higher variability in acceptance than the qualitative reports. Despite suboptimal staff deployment after training and low baseline computer literacy levels, 3626 eIMCI records were captured across 12 sites over 14 weeks, with a median of 19 records per facility per week. Practitioners’ indicators of self-efficacy improved significantly (p < 0.05) post-implementation compared to baseline. Seventy-six percent of caregivers reported a marked difference in experience compared to previous consultations, emphasising the comprehensiveness and efficiency of care. Conclusion: Uptake was promising and acceptance was good, with themes converging across participant groups to highlight improved comprehensiveness and efficiency of service. Limited computer literacy was the principal barrier to uptake. The next steps include incremental scale-up with stronger mentoring and supervision components and evaluations to assess the feasibility, effectiveness and cost-effectiveness of eIMCI implementation. Abbreviations: CDSS: clinical decision support system; CHCs: community health centres; DoH: Department of Health; eIMCI: electronic IMCI; eHealth: electronic health; EHR: electronic health records; ICT: information and communication technology; IMCI: Integrated Management of Childhood Illness; OM: operational managers; PHCs: primary healthcare clinics; SA: South Africa; SSA: sub-Saharan Africa.

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.

Factors inhibiting implementation of Integrated Management of Childhood Illnesses (IMCI) in primary health care (PHC) facilities in Mafikeng sub-district

BackgroundThe main objective of the Integrated Management of Childhood Illnesses (IMCI) strategy was to reduce child mortality and morbidity, which are associated with major childhood illnesses. IMCI offers a comprehensive health programme that is directed at the development needs of children under five years of age. This strategy also focuses on good nutrition, health promotion, immunization and preventive measures, provides counselling services to mothers or care givers, and engenders an appropriate referral system for seriously ill children. PurposeThe purpose of this study was to explore and describe factors inhibiting implementation of IMCI in primary health care (PHC) facilities in selected sub-district of North West Province, South Africa. MethodsA qualitative, exploratory, descriptive-contextual framework was used. The target population of this study was professional nurses (PNs) working in community health centres (CHC) and primary health care (PHC) facilities. The sample size of the study included 15 participants as determined by data saturation reached by the 12th participant. The study included professional nurses trained in IMCI. Data was collected through in-depth individual semi-structured interviews, using an audio tape recorder and field notes, with data transcribed verbatim. Data was analysed using Atlas TI. ResultsParticipants were professional nurses aged between 25 and 50 years. Themes emerging from the data included organizational and structural factors inhibiting IMCI implementation; education, training and awareness; the behaviour and attitude of nurses towards IMCI implementation; and caregiver related factors affecting IMCI implementation. ConclusionThe study revealed that professional nurses need effective support, mentoring and supervision throughout IMCI implementation by the Mother, Child and Women Health (MCWH) coordinators. Caregivers and mothers need to know the importance of providing a comprehensive child history to professional nurses and therefore they need to be encouraged to disclose all relevant information during the IMCI process.

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.

Knowledge and Implementation of Integrated Management of Childhood Illness at East Kalimantan

Pneumonia is the most common cause of morbidity and mortality among young children worldwide. Integrated Management of Childhood Illness (IMCI) is a procedural form in the care of childhood illness which aims to minimize morbidity and mortality rate in children, including pneumonia. This was a cross-sectional study at Samarinda and Kutai Kartanegara community health center from July to October 2015. The health workers’ knowledge was assessed through questionnaire. The quality of IMCI implementation was evaluated through direct observation in primary health care. A total of 46 health workers were involved in this study. Observation of IMCI implementation quality was conducted in 104 children. The majority of respondents (73.9) had sufficient knowledge; however, in terms of direct implementation on the field, most of the respondents (87%) were included in incompetent category. It can be concluded that level of knowledge was related to implementation of cough IMCI in community health center, but the correlation was weak.

Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on

ObjectiveTo assess the extent to which Integrated Management of Childhood Illness (IMCI) has been adopted and scaled up in countries.SettingThe 95 countries that participated in the survey are home to...