Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
BMJ Paediatr Open. 2021 Apr 30;5(1):e001044. doi: 10.1136/bmjpo-2021-001044. eCollection 2021.
The introduction of the WHO's Integrated Management of Childhood Illnesses (IMCI) guidelines in the mid-1990s contributed to global reductions in under-five mortality. However, issues in quality of care have been reported. We aimed to determine resource availability and healthcare worker knowledge of IMCI guidelines in two districts in Malawi.
We conducted a mixed-methods study, including health facility audits to record availability and functionality of essential IMCI equipment and availability of IMCI drugs, healthcare provider survey and focus group discussions (FGDs) with facility staff. The study was conducted between January and April 2019 in Mchinji (central region) and Zomba (southern region) districts. Quantitative data were described using proportions and χ tests; linear regression was conducted to explore factors associated with IMCI knowledge. Qualitative data were analysed using a pragmatic framework approach. Qualitative and quantitative data were analysed and presented separately.
Forty-seven health facilities and 531 healthcare workers were included. Lumefantrine-Artemether and cotrimoxazole were the most available drugs (98% and 96%); while amoxicillin tablets and salbutamol nebuliser solution were the least available (28% and 36%). Respiratory rate timers were the least available piece of equipment, with only 8 (17%) facilities having a functional device. The mean IMCI knowledge score was 3.96 out of 10, and there was a statistically significant association between knowledge and having received refresher training (coeff: 0.42; 95% CI 0.01 to 0.82). Four themes were identified in the FGDs: IMCI implementation and practice, barriers to IMCI, benefits of IMCI and sustainability.
We found key gaps in IMCI implementation; however, these were not homogenous across facilities, suggesting opportunities to learn from locally adapted IMCI best practices. Improving on-going mentorship, training and supervision should be explored to improve quality of care, and programming which moves away from vertical financing with short-term support, to a more holistic approach with embedded sustainability may address the balance of resources for different conditions.
1990 年代中期引入世界卫生组织（世卫组织）的儿童疾病综合管理（IMCI）指南，推动了全球五岁以下儿童死亡率的降低。然而，据报道，在护理质量方面存在问题。我们旨在确定马拉维两个地区的资源可用性和医疗保健工作者对 IMCI 指南的了解。
我们进行了一项混合方法研究，包括对卫生设施进行审计，以记录基本 IMCI 设备的可用性和功能以及 IMCI 药物的可用性，对医疗保健提供者进行调查以及与设施工作人员进行焦点小组讨论（FGD）。该研究于 2019 年 1 月至 4 月在姆钦吉（中部地区）和宗巴（南部地区）地区进行。使用比例和 χ 检验描述定量数据；进行线性回归以探讨与 IMCI 知识相关的因素。使用实用框架方法分析定性数据。分别分析和呈现定性和定量数据。
共纳入 47 家卫生机构和 531 名医疗保健工作者。青蒿琥酯-甲氟喹和复方磺胺甲噁唑是最常用的药物（98%和 96%）；而阿莫西林片剂和沙丁胺醇雾化溶液是最不常用的药物（28%和 36%）。呼吸频率定时器是最不常用的设备，只有 8 个（17%）设施拥有功能齐全的设备。IMCI 知识评分的平均值为 10 分中的 3.96 分，知识得分与接受进修培训之间存在统计学显著关联（系数：0.42；95%CI 0.01 至 0.82）。在 FGD 中确定了四个主题：IMCI 的实施和实践、IMCI 的障碍、IMCI 的益处和可持续性。
我们发现 IMCI 实施方面存在重大差距；然而，这些差距在设施之间并不均匀，这表明有机会从当地适应性最佳 IMCI 实践中学习。应探索改进持续的指导、培训和监督，以提高护理质量，并采用更全面的方法，嵌入可持续性，以取代短期支持的垂直供资，可能会解决不同条件下资源平衡的问题。
