The Integrated Management of Childhood Illness (IMCI) strategy for improving child health has been adopted in many countries.  What impact has it had so far in Tanzania? And is it more cost-effective than conventional approaches to child health care?

A World Health Organisation multi-country evaluation of IMCI was set up to identify information to help improve the delivery of the strategy.  In Tanzania, the study focuses on two rural districts where facility-based components of IMCI are being implemented.  Two neighbouring districts where IMCI was not implemented were included in the study as comparisons.

The researchers compared, in both sets of facilities:

• the care given to sick children attending the facilities
• the health nutritional status of children in the community
• households' responses to their sick children
• and child survival over the period from 1997 to 2002.

They also identified other factors that might influence child survival rates, and collected detailed cost of care data at national, district, hospital, primary care facility and household levels.

In the two intervention districts, Morogoro and Rufiji, the council health management teams (CHMTs) gave high priority to the introduction of IMCI, partly due to technical and financial support from the Tanzania Essential Health Interventions Project.  By mid-2000, they reported that over 80 percent of health workers managing children in primary care facilities had received an 11-day training in IMCI, with about 30 percent of training time spent in clinical practice. 

Further research findings include:

• After the end of the period of phasing in IMCI, more than twice as many children were checked for cough, diarrhoea and fever, and sick children were more likely to be correctly classified and drugs correctly prescribed with IMCI than in comparison districts.
• During the phase-in period, the death rate for children under the age of five was virtually identical in the IMCI and comparison districts. Over the following two years it was 13 percent lower in the IMCI districts.
• Other factors, such as the use of mosquito nets or vitamin A supplements, were either equally prevalent or more prevalent in comparison than in IMCI districts, and so cannot account for the greater reduction in mortality in the IMCI districts.
• The economic costs of IMCI per child were similar to or less than those of conventional child health care.
• IMCI is affordable. District health management teams in Tanzania can implement IMCI using their existing health funds.

The evaluation shows that, with the use of IMCI, case management has improved and mortality rates are lower than in comparison areas.  Facility-based IMCI is good value for money, and these findings support the widespread implementation of this intervention in Tanzania.

No countries in Africa have yet implemented IMCI widely enough to show clear measurable impacts on mortality at national level. The findings suggest that facility-based IMCI can help to reduce child mortality within existing health budgets.

Source(s):
‘Effectiveness and cost of facility-based Integrated Management of Childhood Illness (IMCI) in Tanzania’, The Lancet 364(9445): 1583-1594, by J.R.M. Armstrong Schellenberg et al, 2004

Funded by: World Health Organisation Department of Child and Adolescent Health and Development; Bill and Melinda Gates Foundation; USAID

id21 Research Highlight: 28 July 2005

Further Information:
Joanna Armstrong Schellenberg
London School of Hygiene and Tropical Medicine
50 Bedford Square
London WC1B 3DP
UK

Tel: +44 (0) 20 7299 4720
Contact the contributor: dajobelo@aol.com

World Health Organisation: Department of Child and Adolescent Health and Development

Other related links:
'Better health care for children in Bangladesh: the story so far'

'Managing childhood illness: how effective is IMCI in Tanzania?'

'Class act – IMCI training boosts health workers’ performance'

'Be quick – seeking care for life threatening malaria in southern Tanzania'

'Coverage story: how to deliver better child survival'

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

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