Hoque D M Emdadul, Arifeen Shams E, Rahman Muntasirur, Chowdhury Enayet K, Haque Twaha M, Begum Khadija, Hossain M Altaf, Akter Tasnima, Haque Fazlul, Anwar Tariq, Billah Sk Masum, Rahman Ahmed Ehsanur, Huque Md Hamidul, Christou Aliki, Baqui Abdullah H, Bryce Jennifer, Black Robert E
Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Health Policy Plan. 2014 Sep;29(6):753-62. doi: 10.1093/heapol/czt059. Epub 2013 Sep 13.
The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities.
To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision.
Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities.
Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities.
IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.
儿童疾病综合管理（IMCI）策略包括一级医疗机构中患病儿童的管理指南。这些指南旨在通过确保对儿童健康进行全面评估，并提供算法，将呈现的症状合并为一组疾病分类，供一级医疗机构中接受过IMCI培训的服务提供者进行管理，从而提高护理质量。
调查在实施IMCI培训和支持性监督后，具有不同职前培训水平的两类一级政府服务提供者在五岁以下儿童病例管理方面改进措施的可持续性。
将孟加拉国马特莱农村地区的20家一级医疗机构随机分为IMCI干预组或对照组。IMCI医疗机构的卫生工作者接受病例管理培训和每月一次的支持性监督，其中包括对病例管理的观察以及由经过培训的医生强化技能。对照医疗机构的卫生工作者按照孟加拉国政府标准进行监督。在基线期（2000年）以及干预设施实施IMCI后的两个时间点（2003年和2005年）开展了涉及病例管理观察的医疗机构调查。
接受过仅18个月职前培训的IMCI培训服务提供者在五岁以下患病儿童管理方面的改进与接受过4年职前培训的服务提供者相当。在干预设施中，两类服务提供者的护理质量改进在两年期间都得以维持。
IMCI培训加上定期监督能够维持一级医疗机构中儿童保健质量的改进，即使是在职前培训极少的工作人员中也是如此。这些研究结果可为政府政策制定者提供指导，并提供进一步证据支持扩大定期监督以及将五岁以下患病儿童的管理工作向较低级别服务提供者进行任务转移。
