Department of Community Medicine, St Stephen's Hospital, Delhi, India.
Health Nutrition & WASH, IPE Global Limited, New Delhi, India.
BMJ Open Qual. 2023 Oct;12(Suppl 3). doi: 10.1136/bmjoq-2022-001857.
Integrated management of childhood illness is a globally proven primary care strategy to improve child survival and is being implemented worldwide in countries with high burden of child mortality. Its implementation as Integrated Management of Newborn and Childhood Illness (IMNCI) in India has been challenging.The primary objective of the present work was to assess the feasibility, acceptability and use of an adapted Integrated E Diagnostic Approach (IeDA) that provides e-Learning and improved clinical practices of the primary level health service provider auxiliary nurse midwives (ANMs) to deliver IMNCI services. This India-specific approach was contextualised to the Indian IMNCI programme based on 7 years of IeDA implementation learning from West Africa.The Integrated Management of Neonatal and Childhood Illness pilot was implemented across 80 front-line workers, 70 ANMs and 10 medical officers) in 55 facilities of 3 blocks of Ranchi district, Jharkhand. This report evaluated the feasibility of its use by ANMs only. Based on the results, it can be concluded that it is possible to implement the newly developed application. A total of 2500 cases were managed by ANMs using the application till May 2020. All ANMs used it to provide treatment to the children. 63% of ANMs used it to provide medications, 83% for counselling and 71% for follow-up as per the recommendations. The app is highly acceptable to ANMs for use as a clinical case management tool for childhood illness. There were some improvements in case management in both the age group (0-59 days and 2-12 months) of children. 78% of caregivers responded with their desire to revisit the health facility in future, highlighting the contribution of an e-tool in improving the perception of the caregiver.
儿童疾病综合管理是一种经过全球验证的初级保健策略,可提高儿童生存率,目前正在高儿童死亡率国家实施。印度实施的新生儿和儿童疾病综合管理(IMNCI)面临挑战。本研究的主要目的是评估经过改编的综合电子诊断方法(IeDA)的可行性、可接受性和使用情况,该方法为初级卫生服务提供者辅助护士助产士(ANMs)提供电子学习并改进 IMNCI 服务的临床实践。这种针对印度的方法是根据在西非实施 7 年 IeDA 的经验,针对印度的 IMNCI 方案进行调整的。在印度恰尔肯德邦的 3 个区的 55 个设施中,有 80 名一线工作人员、70 名辅助护士助产士和 10 名医务人员参与了新生儿和儿童疾病综合管理试点项目。本报告仅评估了辅助护士助产士使用该方法的可行性。根据结果可以得出结论,新开发的应用程序是可以实施的。截至 2020 年 5 月,共有 2500 例病例由辅助护士助产士使用该应用程序进行管理。所有辅助护士助产士都使用它来为儿童提供治疗。根据建议,有 63%的辅助护士助产士使用该应用程序为儿童提供药物治疗,83%用于咨询,71%用于随访。该应用程序非常受辅助护士助产士的欢迎,可作为儿童疾病临床病例管理工具使用。在儿童的两个年龄组(0-59 天和 2-12 个月)的病例管理方面都有一些改进。78%的照料者表示希望将来再次访问该卫生机构,这突出了电子工具在改善照料者认知方面的贡献。