Adherence and Implementation-related Challenges of Integrated Management of Childhood Illness Guidelines among Nurses at Health Centers in Port Harcourt, Nigeria

Abstract

Background: The Integrated Management of Childhood Illness (IMCI) guidelines are a standardized diagnostic and treatment approach developed by the World Health Organization for the management of common childhood diseases. Objective: This study assessed the adherence and implementation-related challenges of the IMCI guidelines among nurses at health centers in Port Harcourt, Nigeria. Materials and Methods: A cross-sectional descriptive-analytical design was employed to examine nurses in all the 12 Model Comprehensive Primary Healthcare Centers (MCPHCs) in Port Harcourt, Nigeria. The census sampling technique was used to enroll 52 consenting participants. Data were collected by (1) observation and recording on a checklist and then (2) semi-structured questionnaire. Collected data were analyzed using frequency, percentages, Chi-square, and prevalence ratio at a 5% level of significance with the aid of IBM-SPSS version 25. Results: About half (53.8%) of the participants demonstrated adequate overall adherence to all the steps of the IMCI guidelines. Adequate adherence to all the steps of the IMCI guidelines was 83% higher among participants trained on the IMCI guidelines (P = 0.038). The participants’ educational qualifications (P = 0.722) and years of professional nursing practice (P = 0.477) were not associated with adherence to the IMCI guidelines. The categories of the IMCI guidelines implementation-related challenges reported by the participants were a lack of training update on the IMCI guidelines (94.2%), a lack of the IMCI booklets (69.2%), and work-time pressure (53.8%) among others. Conclusion: Adherence to the IMCI guidelines was short of desired levels. In recommendation, frequent training and regular provision of the IMCI booklets in the MCPHCs are required.

Utilization of the Integrated Management of Newborn and Childhood Illness (IMNCI) protocol and associated factors among health care workers in health centers of South Gondar Zone, Northwest Ethiopia: an institution-based mixed study

“…This rate is higher than that reported in a study conducted in the Oromia region, which showed that the overall IMNCI guideline utilization was 58.7% (6). This is also higher than that in a study conducted in Kenya, in which utilization of the IMNCI protocol by health professionals was only 42% (7), and in Nigeria, in which the overall IMNCI utilization was 53.8% (8). This difference might be due to the increased quality of service provided by health institutions, IMNCI equipment availability, IMNCI training status, and the time of the study conducted.…”

Challenges experienced by nurses regarding the involvement of guardians in integrated management of childhood illnesses in Vhembe District

“…Similarly, a scoping review on challenges with implementing IMCI found that guardians were used to receiving antibiotics and other medicines, so they were frustrated when they only received advice on how to treat their children at home (Reñosa et al, 2021). Similar to the study in Nigeria, some guardians insisted on having prescription medication even when it was not recommended by the IMCI strategy (Amachree & Eleke, 2022).…”

“…Similar studies found that nurses do not avoid implementing IMCI but skip some IMCI steps to hasten workflow and reduce waiting time. (Amachree & Eleke, 2022;USAID & Momentum, 2022). Furthermore, nurses found IMCI laborious and placing undue pressure on nurses who are responsible for all disease control programs, not singularly focused on IMCI (Reñosa et al, 2021).…”