Article

An Evaluation of the Quality of IMCI Assessments among IMCI Trained Health Workers in South Africa

Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
PLoS ONE (Impact Factor: 3.53). 02/2009; 4(6):e5937. DOI: 10.1371/journal.pone.0005937
Source: PubMed

ABSTRACT Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality and morbidity in children under 5 years by improving case management of common and serious illnesses at primary health care level, and was adopted in South Africa in 1997. We report an evaluation of IMCI implementation in two provinces of South Africa.
Seventy-seven IMCI trained health workers were randomly selected and observed in 74 health facilities; 1357 consultations were observed between May 2006 and January 2007. Each health worker was observed for up to 20 consultations with sick children presenting consecutively to the facility, each child was then reassessed by an IMCI expert to determine the correct findings. Observed health workers had been trained in IMCI for an average of 32.2 months, and were observed for a mean of 17.7 consultations; 50/77(65%) HW's had received a follow up visit after training. In most cases health workers used IMCI to assess presenting symptoms but did not implement IMCI comprehensively. All but one health worker referred to IMCI guidelines during the period of observation. 9(12%) observed health workers checked general danger signs in every child, and 14(18%) assessed all the main symptoms in every child. 51/109(46.8%) children with severe classifications were correctly identified. Nutritional status was not classified in 567/1357(47.5%) children.
Health workers are implementing IMCI, but assessments were frequently incomplete, and children requiring urgent referral were missed. If coverage of key child survival interventions is to be improved, interventions are required to ensure competency in identifying specific signs and to encourage comprehensive assessments of children by IMCI practitioners. The role of supervision in maintaining health worker skills needs further investigation.

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    • "Poor systems of supervision and follow-up may be one reason why clinicians do not acknowledge the importance of the IMCI tool. There is ample evidence to show that training alone does not secure adherence to IMCI, that systems to reinforce guidelines over time are needed and that supervision does indeed have an effect in many cases (Anatole et al., 2013; Horwood et al., 2009: 5; Osterholt, Onikpo, Lama, Deming, & Rowe, 2009; Rowe, 2009; Rowe, de Savigny, Lanata, & Victora, 2005; Rowe et al., 2012). The multicountry evaluation of IMCI found that supervision systems were not sustained in any of the countries (Bryce et al., 2005). "
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