Why don't clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)?

Lange, Siri; Mwisongo, Aziza; Mæstad, Ottar

doi:10.1016/j.socscimed.2013.12.020

Cited by 90 publications

(105 citation statements)

References 26 publications

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“…In addition, it has been shown that FBHWs often do not adhere to the Integrated Management of Childhood Illness (IMCI) guidelines (which parallel iCCM guidelines) due to either a lack of belief in their validity or "cognitive overload" due to time pressure. 48 Mature iCCM programs have achieved a consistency with guidelines of approximately 70%, whereas studies of IMCI in a variety of facilities have only demonstrated a maximum of 30% consistency. [48][49][50] Therefore, caregiver faith in CHW ability may be well placed.…”

Section: Discussionmentioning

confidence: 99%

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Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

Shaw

Asadhi

Owuor

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Integrated community case management (iCCM) programs that train lay community health workers (CHWs) in the diagnosis and treatment of diarrhea, malaria, and pneumonia have been increasingly adopted throughout subSaharan Africa to provide services in areas where accessibility to formal public sector health services is low. One important aspect of successful iCCM programs is the acceptability and utilization of services provided by CHWs. To understand community perceptions of the quality of care in an iCCM intervention in western Kenya, we used the Primary Care Assessment Survey to compare caregiver attitudes about the diagnosis and treatment of childhood pneumonia as provided by CHWs and facility-based health workers (FBHWs). Overall, caregivers rated CHWs more highly than FBHWs across a set of 10 domains that capture multiple dimensions of the care process. Caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care on clinical aspects. These results argue for the continued implementation and scale-up of iCCM programs as an acceptable intervention for increasing access to treatment of childhood pneumonia.

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Section: Discussionmentioning

confidence: 99%

“…48 Mature iCCM programs have achieved a consistency with guidelines of approximately 70%, whereas studies of IMCI in a variety of facilities have only demonstrated a maximum of 30% consistency. [48][49][50] Therefore, caregiver faith in CHW ability may be well placed.…”

Section: Discussionmentioning

confidence: 99%

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

Shaw

Asadhi

Owuor

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…). One mechanism for the gap may be low provider effort and time spent in the clinical consultations (Lange, Mwisongo, and Maestad ). Low provider effort combined with resource constraints may result in cursory interactions with low content of clinical care (Mohanan et al.…”

mentioning

confidence: 99%

“…While provider knowledge of treatment guidelines is not optimal, practice is often observed to be even worse, a so-called know-do gap (Mohanan et al 2015). One mechanism for the gap may be low provider effort and time spent in the clinical consultations (Lange, Mwisongo, and Maestad 2014). Low provider effort combined with resource constraints may result in cursory interactions with low content of clinical care (Mohanan et al 2015).…”

mentioning

confidence: 99%

Content of Care in 15,000 Sick Child Consultations in Nine Lower‐Income Countries

Kruk

Gage

Mbaruku

et al. 2018

Health Services Research

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“…This is not surprising given that IMCI training is often targeted to areas with very high child mortality38. It has also been documented that the effectiveness of IMCI can be severely hampered by lack of supplies3940, and low health-worker morale41, all of which could confound the association between IMCI training and mortality in this analysis.…”

Section: Discussionmentioning

confidence: 67%

A retrospective cohort study to quantify the contribution of health systems to child survival in Kenya: 1996–2014

Anthopolos

Simmons

O’Meara

2017

Sci Rep

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Globally, the majority of childhood deaths in the post-neonatal period are caused by infections that can be effectively treated or prevented with inexpensive interventions delivered through even very basic health facilities. To understand the role of inadequate health systems on childhood mortality in Kenya, we assemble a large, retrospective cohort of children (born 1996–2013) and describe the health systems context of each child using health facility survey data representative of the province at the time of a child’s birth. We examine the relationship between survival beyond 59 months of age and geographic distribution of health facilities, quality of services, and cost of services. We find significant geographic heterogeneity in survival that can be partially explained by differences in distribution of health facilities and user fees. Higher per capita density of health facilities resulted in a 25% reduction in the risk of death (HRR = 0.73, 95% CI:0.58 to 0.91) and accounted for 30% of the between-province heterogeneity in survival. User fees for sick-child visits increased risk by 30% (HRR = 1.30, 95% CI:1.11 to 1.53). These results implicate health systems constraints in child mortality, quantify the contribution of specific domains of health services, and suggest priority areas for improvement to accelerate reductions in child mortality.

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Why don't clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)?

Cited by 90 publications

References 26 publications

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

Content of Care in 15,000 Sick Child Consultations in Nine Lower‐Income Countries

A retrospective cohort study to quantify the contribution of health systems to child survival in Kenya: 1996–2014

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