Victora C G, Huicho L, Amaral J J, Armstrong-Schellenberg J, Manzi F, Mason E, Scherpbier R
Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
Bull World Health Organ. 2006 Oct;84(10):792-801. doi: 10.2471/blt.06.030502.
To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs.
We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI. Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years.
In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system. In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics. In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower. In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments. In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts. Implementation was not associated with baseline mortality levels in any country studied.
Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized. Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most.
描述三个国家儿童疾病综合管理（IMCI）策略的实施地理模式，并评估该策略是否在儿童健康需求最紧迫的地区得到实施。
我们在巴西、秘鲁和坦桑尼亚联合共和国的国家和地区层面与关键信息提供者进行了访谈，并对与IMCI卫生工作者培训相关的因素进行了生态研究。解释性因素包括地区人口、与首都的距离、人类发展指数、其他社会经济指标以及五岁以下儿童的基线死亡率。
与世界卫生组织的建议一致，早期实施地区的特点是靠近首都且有合适的培训地点、有积极主动的卫生管理人员以及运转良好的卫生系统。在扩展阶段，具有类似特征的其他地区倾向于采用IMCI。在巴西，贫困和小型城市以及那些离州首府较远的城市的采用率明显较低。在秘鲁，与离利马的距离没有关联，小型和贫困省份采用IMCI的趋势不显著。在坦桑尼亚联合共和国，唯一具有统计学意义的发现是偏远地区的采用率较低。在所研究的任何国家，实施情况与基线死亡率水平均无关联。
虽然为早期使用地区的选择提供了明确合理的指导方针，但尚未发布促进IMCI扩展的标准，最需要的地区也未被列为优先事项。基于新计划和策略地理部署的公平性分析有助于评估它们是否惠及了最需要的人群。
