Arifeen S E, Bryce J, Gouws E, Baqui A H, Black R E, Hoque D M E, Chowdhury E K, Yunus M, Begum N, Akter T, Siddique A
International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh.
Bull World Health Organ. 2005 Apr;83(4):260-7. Epub 2005 Apr 25.
The multi-country evaluation of Integrated Management of Childhood Illness (IMCI) effectiveness, cost and impact (MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. MCE studies are under way in Bangladesh, Brazil, Peru, Uganda and the United Republic of Tanzania. The objective of this analysis from the Bangladesh MCE study was to describe the quality of care delivered to sick children under 5 years old in first-level government health facilities, to inform government planning of child health programmes.
Generic MCE Health Facility Survey tools were adapted, translated and pre-tested. Medical doctors trained in IMCI and these tools conducted the survey in all 19 health facilities in the study areas. The data were collected using observations, exit interviews, inventories and interviews with facility providers.
Few of the sick children seeking care at these facilities were fully assessed or correctly treated, and almost none of their caregivers were advised on how to continue the care of the child at home. Over one-third of the sick children whose care was observed were managed by lower-level workers who were significantly more likely than higher-level workers to classify the sick child correctly and to provide correct information on home care to the caregiver.
These results demonstrate an urgent need for interventions to improve the quality of care provided for sick children in first-level facilities in Bangladesh, and suggest that including lower-level workers as targets for IMCI case-management training may be beneficial. The findings suggest that the IMCI strategy offers a promising set of interventions to address the child health service problems in Bangladesh.
儿童疾病综合管理（IMCI）有效性、成本及影响的多国评估（MCE）是一项全球评估，旨在确定IMCI对健康结果的影响及其成本效益。MCE研究正在孟加拉国、巴西、秘鲁、乌干达和坦桑尼亚联合共和国开展。来自孟加拉国MCE研究的这项分析的目的是描述一级政府卫生设施中为5岁以下患病儿童提供的护理质量，为政府儿童健康项目规划提供信息。
对通用的MCE卫生设施调查工具进行了改编、翻译和预测试。接受过IMCI及这些工具培训的医生在研究区域的所有19个卫生设施中进行了调查。数据通过观察、出院访谈、清单以及与机构提供者的访谈收集。
在这些设施中寻求护理的患病儿童很少得到全面评估或正确治疗，而且几乎没有向他们的照料者提供关于如何在家中继续照料孩子的建议。在接受观察的患病儿童中，超过三分之一由级别较低的工作人员管理，这些工作人员比级别较高的工作人员更有可能正确分类患病儿童，并向照料者提供关于家庭护理的正确信息。
这些结果表明迫切需要采取干预措施来提高孟加拉国一级设施中为患病儿童提供的护理质量，并表明将级别较低的工作人员作为IMCI病例管理培训的对象可能会有益处。研究结果表明，IMCI策略提供了一系列有前景的干预措施来解决孟加拉国的儿童健康服务问题。
