Integrated Management of Childhood Illnesses (IMCI): a mixed-methods study on implementation, knowledge and resource availability in Malawi

Abstract

BackgroundThe introduction of the WHO’s Integrated Management of Childhood Illnesses (IMCI) guidelines in the mid-1990s contributed to global reductions in under-five mortality. However, issues in quality of care have been reported. We aimed to determine resource availability and healthcare worker knowledge of IMCI guidelines in two districts in Malawi.MethodsWe conducted a mixed-methods study, including health facility audits to record availability and functionality of essential IMCI equipment and availability of IMCI drugs, healthcare provider survey and focus group discussions (FGDs) with facility staff. The study was conducted between January and April 2019 in Mchinji (central region) and Zomba (southern region) districts. Quantitative data were described using proportions and χ2 tests; linear regression was conducted to explore factors associated with IMCI knowledge. Qualitative data were analysed using a pragmatic framework approach. Qualitative and quantitative data were analysed and presented separately.ResultsForty-seven health facilities and 531 healthcare workers were included. Lumefantrine-Artemether and cotrimoxazole were the most available drugs (98% and 96%); while amoxicillin tablets and salbutamol nebuliser solution were the least available (28% and 36%). Respiratory rate timers were the least available piece of equipment, with only 8 (17%) facilities having a functional device. The mean IMCI knowledge score was 3.96 out of 10, and there was a statistically significant association between knowledge and having received refresher training (coeff: 0.42; 95% CI 0.01 to 0.82). Four themes were identified in the FGDs: IMCI implementation and practice, barriers to IMCI, benefits of IMCI and sustainability.ConclusionWe found key gaps in IMCI implementation; however, these were not homogenous across facilities, suggesting opportunities to learn from locally adapted IMCI best practices. Improving on-going mentorship, training and supervision should be explored to improve quality of care, and programming which moves away from vertical financing with short-term support, to a more holistic approach with embedded sustainability may address the balance of resources for different conditions.

Perceptions of Undergraduate Medical Students Toward Integrated Management of Childhood Illness (IMCI) Pre-service Education at Sultan Qaboos University, Muscat

“…The outcomes from our study provide evidence advocating the future clinical practice implications of the IMCI training. Medical students will possibly attain substantial knowledge, skills, and best practice advantages from the IMCI training and acquire several opportunities to implement it in future clinical practice [24]. The outcomes from our study may help establish milestones to streamline IMCI training sessions and guidelines in medical schools.…”

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

“…Some guardians do not follow treatment management protocols nor attend clinic follow-ups as advised by nurses (Reñosa et al, 2021). Even more concerning, some guardians are seeking care late at facilities, resulting in children experiencing disease complications that could have been prevented (Kilov et al, 2021). For the strategy to be effective, guardians must be involved at every step, starting with health promotion, disease prevention and management.…”

Rational Use of Antibiotics in Upper Respiratory Tract Infections: A Literature Review

“…Among the major causes of mortality in under-fives, pneumonia stands out as the leading culprit. However, there is evidence to suggest that mortality resulting from lower respiratory diseases, such as asthma, often goes underreported [18]. The primary method for diagnosing pneumonia in primary care across the globe relies heavily on clinical signs, such as cough and rapid breathing.…”