Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis

Abstract

BackgroundAn estimated 6.9 million children die annually in low and middle-income countries because of treatable illneses including pneumonia, diarrhea, and malaria. To reduce morbidity and mortality, the Integrated Management of Childhood Illness strategy was developed, which included a component to strengthen the skills of health workers in identifying and managing these conditions. A systematic review and meta-analysis were conducted to determine whether IMCI training actually improves performance.MethodsDatabase searches of CIHAHL, CENTRAL, EMBASE, Global Health, Medline, Ovid Healthstar, and PubMed were performed from 1990 to February 2013, and supplemented with grey literature searches and reviews of bibliographies. Studies were included if they compared the performance of IMCI and non-IMCI health workers in illness classification, prescription of medications, vaccinations, and counseling on nutrition and admistration of oral therapies. Dersminion-Laird random effect models were used to summarize the effect estimates.ResultsThe systematic review and meta-analysis included 46 and 26 studies, respectively. Four cluster-randomized controlled trials, seven pre-post studies, and 15 cross-sectional studies were included. Findings were heterogeneous across performance domains with evidence of effect modification by health worker performance at baseline. Overall, IMCI-trained workers were more likely to correctly classify illnesses (RR = 1.93, 95% CI: 1.66–2.24). Studies of workers with lower baseline performance showed greater improvements in prescribing medications (RR = 3.08, 95% CI: 2.04–4.66), vaccinating children (RR = 3.45, 95% CI: 1.49–8.01), and counseling families on adequate nutrition (RR = 10.12, 95% CI: 6.03–16.99) and administering oral therapies (RR = 3.76, 95% CI: 2.30–6.13). Trends toward greater training benefits were observed in studies that were conducted in lower resource settings and reported greater supervision.ConclusionFindings suggest that IMCI training improves health worker performance. However, these estimates need to be interpreted cautiously given the observational nature of the studies and presence of heterogeneity.

Community Health Workers and Stand-Alone or Integrated Case Management of Malaria: A Systematic Literature Review

“…With the exception of two studies that successfully improved CHW stock continuity through training of health facility pharmacists,35,42 it was not always clear to what extent such intervention had been effective. A recent systematic review and meta-analysis concluded that training in integrated management of childhood illnesses could improve quality of treatment of childhood illnesses at health facility level, particularly when implemented in conjunction with greater supervision 59. The variety of challenges for those studies in this review that did not have intensive involvement of a research team also support that training alone is insufficient to improve health system capacity; more in-depth assessment of the needs at the supervising health facility level will be needed to design appropriate interventions to support CCM.…”

Streptococcal Pharyngitis in Schoolchildren in Bamako, Mali

“…These scoring systems, which generally include multiple clinical parameters, have been evaluated in middle income countries such as Brazil, 13, 14, 17 , Egypt, 13 , Latvia and Croatia, 15 but it is not known whether they are applicable, feasible, or practical for use in the less developed countries of sub-Saharan Africa where overall implementation of recommended guidelines for clinical care is known to be inadequate. 18, 19 After searching for a simplified approach, we found that a single finding, tender cervical lymph nodes, could identify 89.8% of GAS-positive children with sore throat and when absent could avoid unnecessary antibiotics administration in 28.2% of GAS-negative children. Cervical adenopathy (variously defined as enlargement and/or tenderness) has improved the sensitivity of most decision rules (although not to the extent that we observed) and has been incorporated into numerous models.…”

Longitudinal analysis of the capacities of community health workers mobilized for seasonal malaria chemoprevention in Burkina Faso

“…Many studies have shown that the personal characteristics of community health workers can be associated with their performance [8,11,15,27], suggesting that the CBDs to be trained should be carefully selected [11,28]. However, recent reviews reveal that results, particularly with regard to performance compared by type and sex, are not always consistent [12], and that "studies of workers with lower baseline performance showed greater improvements in prescribing medications…, vaccinating children,… and counseling…" [29]. As well, the more educated CBDs, who are traditionally more productive, are also less committed and more likely to drop out [8,11,15,27].…”