© 2005 BMJ Publishing Group & Royal College of Paediatrics and Child Health
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The Integrated Management of Childhood Illness (IMCI) approach has been developed by the WHO and UNICEF to impact on the common causes of mortality in young children—acute respiratory infection, diarrhoeal disease, malaria, measles, neonatal causes, malnutrition, and HIV/AIDS. In an important report from South Africa, Chopra and colleagues, using a pre-post design, describe significant changes in a number of process measures, including improvement in assessment of co-morbidity and danger signs in sick children (eg, lethargic/unconsciousness, vomiting), rational prescribing, and first dose of appropriate treatment provided in clinic. A number of other important process measures, such as treatment of anaemia and prescribing of vitamin A, did not change. These results are not surprising—it will take many years of concerted effort to implement IMCI around the world and potentially longer to determine, using a rigorous trial design, if mortality improves. Because of the highly variable nature of health care delivery and the
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