Using Electronic Technology to Improve Clinical Care -- Results from a Before-after Cluster Trial to Evaluate Assessment and Classification of Sick Children According to Integrated Management of Childhood Illness (IMCI) Protocol in Tanzania.

Poor adherence to the Integrated Management of Childhood Illness (IMCI) protocol reduces the potential impact on under-five morbidity and mortality. Electronic technology could improve adherence; however there are few studies demonstrating the benefits of such technology in a resource-poor settings. This study estimates the impact of electronic technology on adherence to the IMCI protocols as compared to the current paper-based protocols in Tanzania. In four districts in Tanzania, 18 clinics were randomly selected for inclusion. At each site, observers documented critical parts of the clinical assessment of children aged 2 months to 5 years. The first set of observations occurred during examination of children using paper-based IMCI (pIMCI) and the next set of observations occurred during examination using the electronic IMCI (eIMCI). Children were re-examined by an IMCI expert and the diagnoses were compared. A total of 1221 children (671 paper, 550 electronic) were observed. For all ten critical IMCI items included in both systems, adherence to the protocol was greater for eIMCI than for pIMCI. The proportion assessed under pIMCI ranged from 61% to 98% compared to 92% to 100% under eIMCI (p < 0.05 for each of the ten assessment items). Use of electronic systems improved the completeness of assessment of children with acute illness in Tanzania. With the before-after nature of the design, potential for temporal confounding is the primary limitation. However, the data collection for both phases occurred over a short period (one month) and so temporal confounding was expected to be minimal. The results suggest that the use of electronic IMCI protocols can improve the completeness and consistency of clinical assessments and future studies will examine the long-term health and health systems impact of eIMCI

Prioritising the care of critically ill children: a pilot study using SCREEN reduces clinic waiting times

Objective In low-resource settings, childhood mortality secondary to delays in triage and treatment remains high. This paper seeks to evaluate the impact of the novel Sick Children Require Emergency Evaluation Now (SCREEN) tool on the waiting times of critically ill children who present for care to primary healthcare clinics in Cape Town, South Africa. Methods We used a pre/postevaluation study design to calculate the median waiting times of all children who presented to four randomly chosen clinics for 5 days before, and 5 days after, the implementation of SCREEN. Findings The SCREEN programme resulted in statistical and clinically significant reductions in waiting times for children with critical illness to see a professional nurse (2 hours 45 min to 1 hour 12 min; p<0.001). There was also a statistically significant reduction in the proportion of children who left without being seen by a professional nurse (25.8% to 18.48%; p<0.001). Conclusions SCREEN is a novel programme that uses readily available laypersons, trained to make a subjective assessment of children arriving at primary healthcare centres, and provides a low cost, simple methodology to prioritise children and reduce waiting times in low-resource healthcare clinics

Teaching of the Integrated Management of Childhood Illness strategy in undergraduate nursing programs

Objective: To describe and analyze the teaching of the Integrated Management of hildhood Illness (IMCI) strategy on Brazilian undergraduate nursing programs. Method: Integrating an international multicentric study, a cross-sectional online survey was conducted between May and October 2010 with 571 undergraduate nursing programs in Brazil Results: Responses were received from 142 programs, 75% private and 25% public. 64% of them included the IMCI strategy in the theoretical content, and 50% of the programs included IMCI as part of the students’ practical experience. The locations most used for practical teaching were primary health care units. The ‘treatment’ module was taught by the fewest number of programs, and few programs had access to the IMCI instructional manuals. All programs used exams for evaluation, and private institutions were more likely to include class participation as part of the evaluation. Teaching staff in public institutions were more likely to have received training in teaching IMCI. Conclusion: In spite of the relevance of the IMCI strategy in care of the child, its content is not addressed in all undergraduate programs in Brazil, and many programs do not have access to the IMCI teaching manuals and have not provide training in IMCI to their teaching staff

Implementation of Integrated Management of Sick Infant in the Stunting Prevalence Area, Kupang Regency, East Nusa Tenggara Province, Indonesia

One of the strategies to reduce morbidity due to malnutrition and under-five mortality is the implementation of Integrated Management of Child Diseases (IMCI).  Stunting is a form of pain due to acute malnutrition that occurs in the long term so that it has an impact on the growth and development of children. The province of East Nusa Tenggara is one of the regions that contributes to the high prevalence of stunting in Indonesia. This study aims to determine the effect of the competence of health workers and health system management on the implementation of IMCI.  Data of the study were derived from a cross-sectional study conducted at Community Health Centers (CHC) of Kupang district from March to April 2021. Structured interviewed was applied to obtain information from 80 informants of IMCI healthcare workers. Quantitative datawere analyzed using Chi-square Analysis and Multiple Logistic Regression.  Based on chi square testshowed thatthere wasa significant association between healthcare workers competence variables such as knowledge (pvalue=0.026), attitude (pvalue=0.045), skill (pvalue=0.043), training (pvalue=0.000), and health system management variable namely  supervision (pvalue=0.045) against the implementation of IMCI. Health system management variables thathad no significant association with the implementation of IMCI were the availability oflogistic, record keeping and reporting system, and fund allocation. Competence of IMCI health workers and Health System Management are variables that have a statistically significant relationship with the implementation of IMCI. Simultaneously it is known that the variables of IMCI training and supervision of IMCI have a significant influence on the implementation of IMCI

Perspektif Perawat Tentang Manejemen Terpadu Balita Sakit di Puskesmas Wilayah Kabupaten Bantul Yogyakarta

Integrated Management of Childhood Illness (IMCI) is an integrated approach to the treatment of sick children in primary helath care services which include promotive, preventive and curative programs. The role of nurses in providing nursing care must be in accordance with the system of the health care centers. The purpose of this study was to determine Nurses Perspective on Integrated Management of Childhood Illness (IMCI) in Primary Health Care Centres, Bantul, Yogyakarta. The method used in this research is descriptive qualitative. The sampling was recruited by purposive sampling, 6 respondents was involved in this research. Data analysis was done by thematic analysis. The results of this study found that 5 out of 6 respondents can explain IMCI defi nition, objectives and actions of nurses that had been taken in IMCI. Respondents said that the biggest obstacle in implementing IMCI at health centers is the time, facilities and infrastructures. Sources like fi nancial support and the support of the leadership is very important to support the implementation of IMCI in health centers. Based on this research can be concluded that the implementation of IMCI in PHC requires the commitment of all parties, not only nurses but also doctors, health center leaders and other health workers. Advice can be given to Primary Health Care Centres associated with IMCI is conducting training for nurses, repair facilities and infrastructure so that implementation of IMCI in health centers could have better.Keywords: Nurse, Knowledge Level, IMCI, Health Cente

The usefulness of rapid diagnostic tests in the new context of low malaria transmission in zanzibar.

BACKGROUND\ud \ud We assessed if histidine-rich-protein-2 (HRP2) based rapid diagnostic test (RDT) remains an efficient tool for Plasmodium falciparum case detection among fever patients in Zanzibar and if primary health care workers continue to adhere to RDT results in the new epidemiological context of low malaria transmission. Further, we evaluated the performance of RDT within the newly adopted integrated management of childhood illness (IMCI) algorithm in Zanzibar.\ud \ud METHODS AND FINDINGS\ud \ud We enrolled 3890 patients aged ≥2 months with uncomplicated febrile illness in this health facility based observational study conducted in 12 primary health care facilities in Zanzibar, between May-July 2010. One patient had an inconclusive RDT result. Overall 121/3889 (3.1%) patients were RDT positive. The highest RDT positivity rate, 32/528 (6.1%), was found in children aged 5-14 years. RDT sensitivity and specificity against PCR was 76.5% (95% CI 69.0-83.9%) and 99.9% (95% CI 99.7-100%), and against blood smear microscopy 78.6% (95% CI 70.8-85.1%) and 99.7% (95% CI 99.6-99.9%), respectively. All RDT positive, but only 3/3768 RDT negative patients received anti-malarial treatment. Adherence to RDT results was thus 3887/3889 (99.9%). RDT performed well in the IMCI algorithm with equally high adherence among children <5 years as compared with other age groups.\ud \ud CONCLUSIONS\ud \ud The sensitivity of HRP-2 based RDT in the hands of health care workers compared with both PCR and microscopy for P. falciparum case detection was relatively low, whereas adherence to test results with anti-malarial treatment was excellent. Moreover, the results provide evidence that RDT can be reliably integrated in IMCI as a tool for improved childhood fever management. However, the relatively low RDT sensitivity highlights the need for improved quality control of RDT use in primary health care facilities, but also for more sensitive point-of-care malaria diagnostic tools in the new epidemiological context of low malaria transmission in Zanzibar.\ud \ud TRIAL REGISTRATION\ud \ud ClinicalTrials.gov NCT01002066

Evaluating Niger's experience in strengthening supervision, improving availability of child survival drugs through cost recovery, and initiating training for Integrated Management of Childhood Illness (IMCI)

BACKGROUND: WHO and UNICEF have recently developed the "Integrated Management of Childhood Illness" (IMCI) as an efficient strategy to assist developing countries reduce childhood mortality. Early experience with IMCI implementation suggests that clinical training is essential but not sufficient for the success of the strategy. Attention needs to be given to strengthening health systems, such as supervision and drug supply. RESULTS: This paper presents results of evaluating an innovative approach for implementing IMCI in Niger. It starts with strengthening district level supervision and improving the availability of child survival drugs through cost recovery well before the beginning of IMCI clinical training. The evaluation documented the effectiveness of the initial IMCI clinical training and referral. CONCLUSIONS: Strengthening supervision and assuring the availability of essential drugs need to precede the initiation of IMCI Clinical training. Longer term follow up is necessary to confirm the impact of the approach on IMCI preparation and implementation

Family practices that influence the uptake of the Intergrated Management of Childhood Illnesses (IMCI) strategy among mothers at the MCH/FP clinic at Pumwani Maternity Hospital, Kenya

Background: Since 1999 the Government of Kenya has introduced the Integrated Management of Childhood Illness (IMCI) in an attempt to reduce child mortality. The IMCI strategy, developed by WHO and UNICEF, aims to improve the management of childhood illness at the primary health care level. The aim of this study was to determine the family practices that influence the uptake of the IMCI strategy among mothers in the MCH/FP clinic at Pumwani Maternity Hospital. Methods: A cross sectional survey was conducted at Pumwani Maternity Hospital MCH/FP clinic. A sample size of 385 mothers at the MCH/FP clinic was interviewed for quantitative data. All independent variables identified to significantly associate with ‘uptake of IMCI’ at bivariate analysis was considered together in a multivariate analysis. SPSS version 22 was used for statistical analysis. Results: Out of the 385 respondents interviewed, 78.4% children were well, 74.3% were of normal weight and 88.6% had been fully immunized. At multivariate analysis, statistically significant predictor family practices of IMCI uptake were fever experience, cough experience, living in Nairobi and giving iron supplements to the children.Conclusion: The uptake of the IMCI strategy, though high, was not optimal. There were many children who were underweight, had illnesses and were not fully immunized. These findings highlight the need for continuous strengthening of the IMCI strategy in health facilities