Krüger Carsten, Heinzel-Gutenbrunner Monika, Ali Mohammed
Department of Paediatrics, Witten/Herdecke University, Witten, Germany.
Children's Hospital, St. Franziskus Hospital, Robert-Koch-Strasse 55, D-59227, Ahlen, Germany.
BMC Health Serv Res. 2017 Dec 13;17(1):822. doi: 10.1186/s12913-017-2781-3.
Integrated Management of Childhood Illness (IMCI) is regarded as a standard public health approach to lowering child mortality in developing countries. However, little is known about how health workers adhere to the guidelines at the national level in sub-Saharan African countries.
Data from the Service Provision Assessment surveys of Namibia (NA) (survey year: 2009), Kenya (KE) (2010), Tanzania (TZ) (2006) and Uganda (UG) (2007) were analysed for adherence to the IMCI guidelines by health workers. Potential influencing factors included the survey country, patient's age, the different levels of the national health system, the training level of the health care provider (physician, non-physician clinician, nurse-midwife, auxiliary staff), and the status of re-training in IMCI.
In total, 6856 children (NA: 1495; KE: 1890; TZ: 2469; UG: 1002 / male 51.2-53.5%) aged 2-73 months (2-24 months, 65.3%; median NA: 19 months; KE: 18 months; TZ: 16 months; UG: 15 months) were clinically assessed by 2006 health workers during the surveys. Less than 33% of the workers carried out assessment of all three IMCI danger signs, namely inability to eat/drink, vomiting everything, and febrile convulsions (NA: 11%; KE: 11%; TZ: 14%; UG: 31%) while the rate for assessing all three of the IMCI main symptoms of cough/difficult breathing, diarrhoea, and fever was < 60% (NA: 48%; KE: 34%; TZ: 50%; UG: 57%). Physical examination rates for fever (temperature) (NA: 97%; KE: 87%; TZ: 73%; UG: 90%), pneumonia (respiration rate/auscultation) (NA: 43%; KE: 24%; TZ: 25%; UG: 20%) and diarrhoea (dehydration status) (NA: 29%; KE: 19%; TZ: 20%; UG: 39%) varied widely and were highest when assessing children with the actual diagnosis of pneumonia and diarrhoea. Adherence rates tended to be higher in children ≤ 24 months, at hospitals, among higher-qualified staff (physician/non-physician clinician) and among those with recent IMCI re-training.
Despite nationwide training in IMCI the adherence rates for assessment and physical examination remained low in all four countries. IMCI training should continue to be provided to all health staff, particularly nurses, midwives, and auxiliary staff, with periodic re-training and an emphasis to equally target children of all age groups.
儿童疾病综合管理（IMCI）被视为发展中国家降低儿童死亡率的标准公共卫生方法。然而，对于撒哈拉以南非洲国家的卫生工作者在国家层面如何遵循这些指南，人们了解甚少。
分析了纳米比亚（NA）（调查年份：2009年）、肯尼亚（KE）（2010年）、坦桑尼亚（TZ）（2006年）和乌干达（UG）（2007年）服务提供评估调查的数据，以了解卫生工作者对IMCI指南的遵循情况。潜在影响因素包括调查国家、患者年龄、国家卫生系统的不同级别、卫生保健提供者（医生、非医生临床医生、助产护士、辅助人员）的培训水平以及IMCI再培训状况。
在调查期间，2006名卫生工作者对总共6856名年龄在2至73个月（2至24个月，65.3%；NA中位数：19个月；KE：18个月；TZ：16个月；UG：15个月）的儿童（NA：1495名；KE：1890名；TZ：2469名；UG：1002名/男性51.2 - 53.5%）进行了临床评估。不到33%的工作人员对IMCI的所有三个危险体征进行了评估，即无法进食/饮水、呕吐不止和热性惊厥（NA：11%；KE：11%；TZ：14%；UG：31%），而对IMCI的咳嗽/呼吸困难、腹泻和发热这三个主要症状进行全面评估的比例<60%（NA：48%；KE：34%；TZ：50%；UG：57%）。发热（体温）（NA：97%；KE：87%；TZ：73%；UG：90%）、肺炎（呼吸频率/听诊）（NA：43%；KE：24%；TZ：25%；UG：20%）和腹泻（脱水状况）（NA：29%；KE：19%；TZ：20%；UG：39%）的体格检查率差异很大，在实际诊断为肺炎和腹泻的儿童评估中最高。在24个月及以下的儿童、医院、高素质工作人员（医生/非医生临床医生）以及最近接受过IMCI再培训的人员中，遵循率往往更高。
尽管在全国范围内开展了IMCI培训，但这四个国家在评估和体格检查方面的遵循率仍然很低。应继续为所有卫生工作人员，特别是护士、助产士和辅助人员提供IMCI培训，定期进行再培训，并强调平等针对所有年龄组的儿童。
