Eleven million children under the age of five die each year in low and middle income countries.  The World Health Organisation and UNICEF have developed the Integrated Management of Childhood Illness (IMCI) strategy to address child health problems.  The WHO coordinated evaluation of IMCI effectiveness, cost and impact in Tanzania suggests that the strategy is an effective 'best practice' framework for the reduction of child deaths and the improvement of quality of care to the under-fives.

In Tanzania, if we exclude perinatal problems, just four illnesses (malaria, pneumonia, malnutrition and diarrhoea) account for over 83% of deaths among the under-fives.  The Ministry of Health has recommended that its district health programmes adopt IMCI to reduce childhood mortality and improve health outcomes.

The study in Tanzania was based in the four districts of Rufiji, Morogoro, Kilombero and Ulanga, two of which had been implementing IMCI since 1997, and two that began IMCI implementation in 2002.  In August 2000 a survey was conducted of government health facilities to compare the quality of case management and health systems support in the IMCI districts to those that had not implemented the strategy.

The results of the survey included:

• Children in IMCI district received more thorough assessments and were more likely to be correctly diagnosed and to receive appropriate treatment than those in comparison districts.
• Vaccination status was checked in 93% of children observed in IMCI districts, compared to 24% in comparison districts.
• Those caring for sick children were routinely informed of how to look after their children and how to administer medicines, whilst only a minority was informed in comparison districts.
• Availability of vaccines and oral treatments was similar in IMCI and comparison districts.  Vaccination support services, including availability of equipment and supplies, were significantly worse in IMCI districts.
• Rates of referral for seriously ill children were low in all areas, at 17% and 20% respectively in IMCI and comparison areas.
• Supportive supervision, involving observation of case management, was much more common in the IMCI districts than in comparison districts.

Results indicate that case management of sick children is improved by IMCI training. Findings suggest policy-makers should recognise that:

• it is not possible to separate the impact of IMCI from that of the relatively strong health system and good managerial capacity that exists at district level, and so the study findings cannot necessarily be applied to areas with weaker health systems
• for combating malaria, IMCI can lead to improvements in the correct treatment of suspected malaria in health facilities

IMCI is feasible for implementation in resource-poor countries, and can lead to rapid gains in child survival, health and development if levels of coverage are adequate.

Source(s):
‘The effect of Integrated Management of Childhood Illness on observed quality of care of under-fives in rural Tanzania’ Health Policy and Planning 19(1): 1-10, by the Tanzania IMCI Multi-Country Evaluation Health Facility Study Group, 2004

Funded by: WHO; Bill and Melinda Gates Foundation; USAID

id21 Research Highlight: 28 April 2004

Further Information:
Joanna Armstrong Schellenberg
Gates Malaria Partnership
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Contact the contributor: DaJoBeLo@aol.com

World Health Organisation

UNICEF

Other related links:
'Young, poor and sick: socioeconomic inequities and child health in rural Tanzania'

'Hitting the mark: can under five mortality be cut by two thirds?'

'Danger in disguise – spotting the warning signs of severe childhood illnesses' >

'Decisions, decisions – adapting the IMCI approach for Kenayn paediatric hospitals'

'Rapid response – diagnosing bacterial meningitis in primary healthcare settings'

See id21's collection of links relevant to maternal and child health.

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