Integrated Management of Childhood Illness (IMCI) Approach in Management of Children with High Grade Fever ≥ 39o

Sallam, Salem A.; El-Mazary, Abdel-Azeem M.; Osman, Ashraf

doi:10.12816/0048816

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…Integrated management guidelines developed for these settings are therefore largely dependent on clinical diagnosis with its well-recognised limitations [ 7 , 8 ]. Use of these guidelines has promoted early treatment of pneumonia [ 9 ], improved patient outcomes [ 10 ], and reduced healthcare cost [ 11 ], but may also lead to both overprescription and missed treatment opportunities [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical management and outcomes of acute febrile illness in children attending a tertiary hospital in southern Ethiopia

et al. 2022

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Background The management of febrile illnesses is challenging in settings where diagnostic laboratory facilities are limited, and there are few published longitudinal data on children presenting with fever in such settings. We have previously conducted the first comprehensive study of infectious aetiologies of febrile children presenting to a tertiary care facility in Ethiopia. We now report on clinicians’ prescribing adherence with guidelines and outcomes of management in this cohort. Methods We consecutively enrolled febrile children aged 2 months and under 13 years, who were then managed by clinicians based on presentation and available laboratory and radiologic findings on day of enrolment. We prospectively collected outcome data on days 7 and 14, and retrospectively evaluated prescribing adherence with national clinical management guidelines. Results Of 433 children enrolled, the most common presenting syndromes were pneumonia and acute diarrhoea, diagnosed in 177 (40.9%) and 82 (18.9%), respectively. Antibacterial agents were prescribed to 360 (84.7%) of 425 children, including 36 (34.0%) of 106 children without an initial indication for antibacterials according to guidelines. Antimalarial drugs were prescribed to 47 (11.1%) of 425 children, including 30 (7.3%) of 411 children with negative malaria microscopy. Fever had resolved in 357 (89.7%) of 398 children assessed at day 7, and in-hospital death within 7 days occurred in 9 (5.9%) of 153 admitted patients. Among children with pneumonia, independent predictors of persisting fever or death by 7 days were young age and underweight for age. Antibacterial prescribing in the absence of a guideline-specified indication (overprescribing) was more likely among infants and those without tachypnea, while overprescribing antimalarials was associated with older age, anaemia, absence of cough, and higher fevers. Conclusion Our study underscores the need for improving diagnostic support to properly guide management decisions and enhance adherence by clinicians to treatment guidelines.

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Section: Introductionmentioning

confidence: 99%

Clinical management and outcomes of acute febrile illness in children attending a tertiary hospital in southern Ethiopia

et al. 2022

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“…Non-government organizations contributed to the implementation of the IMCI, which is a strategy for reducing mortality and morbidity associated with major causes of childhood illnesses with the Government of Sierra Leone reinforcing institutional capacity for the treatment of acute malnutrition, prevention of malnutrition and national sensitization for nutrition security [ 8 ]. This also contributes to the early diagnosis and management of febrile children under-five [ 9 ]. In addition, for respiratory and diarrheal diseases, a series of vaccines has been recommended for children under-five years.…”

Section: Introductionmentioning

confidence: 99%

What are the trends in seeking health care for fever in children under-five in Sierra Leone? evidence from four population-based studies before and after the free health care initiative

Bognini

Samadoulougou

Ouédraogo³

et al. 2022

PLoS ONE

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Background In 2010, the government of Sierra Leone implemented the Free Health Care Initiative (FHCI) in the country with the objective of reducing the high maternal, infant, and child mortality rates and improving general health indicators. The objective of this study was to assess the trends in the prevalence of health care-seeking and to identify the determinants of healthcare service utilization by caregivers of children younger than five years. Methods The analysis of health-care-seeking behavior was done using data from four population-based surveys in Sierra Leone before (2008) and after (2013, 2016, 2019) the FHCI was implemented. Care-seeking behavior was assessed with regard to caregivers seeking care for children under-five in the two weeks prior to each survey. We compared the percentages of healthcare-seeking behavior change and identify factors associated with healthcare-seeking using a modified Poisson regression model with generalized estimating equations. Results In 2008, a total of 1208 children with fever were recorded, compared with 2823 children in 2013, 1633 in 2016, and 1464 in 2019. Care-seeking for children with fever was lowest in 2008 (51%; 95% CI (46.4−55.5)) than in 2013 (71.5%; 95% CI (68.4−74.5)), 2016 (70.3%; 95% CI (66.6−73.8)), and 2019 (74.6%; 95% CI (71.6−77.3)) (p < 0.001). Care-seeking in 2013, 2016 and 2019 was at least 1.4 time higher than in 2008 (p < 0.001) after adjusting for mother’s age, wealth, religion, education level, household head and the child’s age. Care-seeking was lowest for children older than 12 months, mothers older than 35 years, children living in the poorest households, and in the northern region. A trend was observed for the sex of the household head. The level of care-seeking was lowest when the household head was a man. Conclusions The increase in healthcare-seeking for children under-five with fever followed the introduction of the FHCI in Sierra Leone. Care-seeking for fever varied by the child’s age, caregiver’s age, household wealth, the sex of the household head and region. Maintaining the FHCI with adequate strategies to address other barriers beyond financial ones is essential to reduce disparities between age groups, regions and, households.

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“…4 Implementation of standardised guidelines, such as the WHO's Integrated Management of Childhood Illnesses (IMCI) has resulted in considerable reductions in pneumonia mortality. [5][6][7] However, these guidelines are often implemented poorly, and a lack of supportive supervision structures can lead to lapses in coverage. 8 At the community level, current WHO recommendations state that all children with fast breathing are classified as having "pneumonia" and treated with high dose oral amoxicillin, while children with chest-indrawing or danger-sign pneumonia should be referred to a higher level.…”

Section: Introductionmentioning

confidence: 99%

Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria

Shittu

Agwai

Falade

et al. 2020

Pediatric Pulmonology

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Integrated Management of Childhood Illness (IMCI) Approach in Management of Children with High Grade Fever ≥ 39o

Cited by 7 publications

References 21 publications

Clinical management and outcomes of acute febrile illness in children attending a tertiary hospital in southern Ethiopia

Clinical management and outcomes of acute febrile illness in children attending a tertiary hospital in southern Ethiopia

What are the trends in seeking health care for fever in children under-five in Sierra Leone? evidence from four population-based studies before and after the free health care initiative

Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria

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