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Integrated management of childhood illness

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The Integrated Management of Childhood Illness (IMCI) strategy was proposed by the World Health Organization in the mid-1990s. It sought to improve the health of children in developing countries by improving health systems, family and community care, and the skills of local health workers. The governments of almost all developing countries have adopted IMCI, apparently with varying degrees of commitment. The effectiveness of IMCI is to be measured by Multi-Country Evaluation (MCE) with studies in Bangladesh, Brazil, Peru, Tanzania, and Uganda. Reports from Tanzania and Bangladesh have been published (

;

; see also Comment, ibid: 1557–8).

In Tanzania, between 1997 and 2002, two districts with facility-based IMCI were compared with two districts that had not yet introduced IMCI. In the IMCI districts >80% of child health workers attended an 11-day training course and information tools were provided from the Tanzania Essential Health Interventions Project. Over a period of 2 years mortality in children <5 years was 13% lower in IMCI districts than in control districts (3.8 fewer deaths per 1000 child-years). There were improvements in the provision of and access to satisfactory health care and IMCI did not increase the cost of child health care.

In Bangladesh 20 first-level outpatient facilities were randomised to IMCI or control groups. In the IMCI facilities a higher proportion of sick children (19% vs 9%) were taken to a health worker, and the number of visits per child increased more than threefold (0.6 vs 1.9 visits per child per year). Children in IMCI facilities were more likely to receive appropriate treatment (“index of correct treatment” on a 0–100 scale, 54 (IMCI) vs 9 (control)).

The introduction of IMCI in Tanzania and Bangladesh has been followed by improvements in the quality, availability, and uptake of child health services. Government enthusiasm for implementing the strategy seems to vary and implementation of the household and community arm seems particularly challenging. Dr Davidson R Gwatkin in his Lancet commentary remarks that in most countries the basic health system is too weak to allow for more than nominal execution of IMCI.

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