远程学习与标准培训在儿童疾病综合管理中的效果比较：一项整群随机对照试验

Effectiveness of a distance-learning vs standard training in the integrated management of childhood illnesses: a cluster randomized controlled trial.

作者信息

Abrar Saidul, Hafeez Assad, Rahim Sana, Doi Suhail A R, Khan Muhammad Naseem

机构信息

Department of Community Medicine, Gajju Khan Medical College, Swabi, Pakistan.

World Health Organization KW, Kuwait City, Kuwait.

出版信息

BMC Public Health. 2025 Jul 21;25(1):2521. doi: 10.1186/s12889-025-21771-y.

DOI:10.1186/s12889-025-21771-y

PMID:40691783

Abstract

BACKGROUND

The Integrated Management of Childhood Illnesss (IMCI) strategy has a lower coverage. The World Health Organization (WHO) introduced the concept of distance learning IMCI in 2014 to improve uptake of the strategy. This study was conducted to evaluate the effectiveness of a distance learning IMCI training compared with the standard IMCI training in the correct management of children presenting to primary health centers.

METHODS

This cluster randomized controlled trial with a 1:1 parallel design was conducted at 26 Basic Health Units (BHUs) in Pakistan. Healthcare workers in BHUs (n = 13) randomized to the intervention arm were trained as per the dIMCI protocols while those (n = 13) randomized to the control arm were trained as per the standard protocol. The trained heathcare workers were followed for around five months and were evaluated in the management of childhood illnesses at their respective health facilities. Correct management, the principal outcome, was defined based on a case being correctly assessed (proficiency score of ≥ 6 out of the total score of 10), classified (compared to the gold standard physician), treated (compared to the gold standard physician), and counseled (proficiency score of ≥ 5 out of the total score of 7). Descriptive statistics, binary logistic regression, and 95% confidence interval were calculated using Stata version 18 adjusted for the clusters. P-values < 0.05 were regarded as significant.

RESULTS

Under-five children presented to the two arms were mostly similar in gender, age, duration of consultation with the healthcare worker, and presenting complaints. On logistic regression, the dIMCI training was found to be a significant factor in the correct classification (OR = 1.77, 95% CI 1.22-2.58), correct counseling (OR = 6.11,95% CI 3.06 - 12.19), and the overall management of children (OR = 3.35, 95% CI 2.03 - 5.52) with strong evidence against the model hypothesis at this sample size. The dIMCI training showed weak evidence against the model hypothesis in the domains of correct assessment (OR = 1.84, 95% CI 0.99-3.40) and correct treatment (OR 1.46, 95% CI 0.92 - 2.31).

CONCLUSIONS

Health policymakers could consider the dIMCI an effective, feasible, and flexible alternative to standard IMCI training for scaling up the IMCI strategy.

TRIAL REGISTRATION

Registered with www.chictr.org.cn , under ChiCTR1900027201 on 05/11/2019.

摘要

背景

儿童疾病综合管理（IMCI）策略的覆盖率较低。世界卫生组织（WHO）于2014年引入了IMCI远程学习的概念，以提高该策略的采用率。本研究旨在评估与标准IMCI培训相比，远程学习IMCI培训在基层医疗中心对就诊儿童进行正确管理的有效性。

方法

本集群随机对照试验采用1:1平行设计，在巴基斯坦的26个基本卫生单位（BHU）进行。随机分配到干预组的BHU中的医护人员（n = 13）按照dIMCI方案进行培训，而随机分配到对照组的医护人员（n = 13）按照标准方案进行培训。对经过培训的医护人员进行了约五个月的随访，并在其各自的医疗机构对儿童疾病管理情况进行评估。主要结局指标“正确管理”的定义为：病例得到正确评估（在满分10分中熟练度得分≥6分）、分类正确（与金标准医生相比）、治疗正确（与金标准医生相比）以及咨询正确（在满分7分中熟练度得分≥5分）。使用Stata 18版本计算描述性统计量、二元逻辑回归和95%置信区间，并对集群进行了调整。P值<0.05被视为具有统计学意义。

结果

两组中就诊的五岁以下儿童在性别、年龄、与医护人员的咨询时长以及就诊主诉方面大多相似。在逻辑回归分析中，发现dIMCI培训是儿童正确分类（OR = 1.77，95% CI 1.22 - 2.58）、正确咨询（OR = 6.11，95% CI 3.06 - 12.19）以及整体管理（OR = 3.35，95% CI 2.03 - 5.52）的一个重要因素，在该样本量下有强有力的证据反对模型假设。在正确评估（OR = 1.84，95% CI 0.99 - 3.40）和正确治疗（OR = 1.46，95% CI 0.92 - 2.31）领域，dIMCI培训显示出较弱的证据反对模型假设。