The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64660

Paula E. Brentlinger, MD, MPH¹, Stephen Morris², Kenneth Sherr, MPH³, Maria Ana Chadreque Correia³, and Stephen Gloyd, MD, MPH⁴. (1) International Health Program, Department of Health Services, University of Washington, Box 354809, University of Washington, Seattle, WA 98195, (206) 543-8382, brentp2@u.washington.edu, (2) School of Medicine, University of Washington, A-300 Health Sciences, Box 356340, University of Washington, Seattle, WA 98195, (3) Health Alliance International, Health Alliance International, PO Box 1227, Mutare, Zimbabwe, (4) Health Services/International Health, University of Washington, 1959 NE Pacific Street, H-660 P.O. Box 357660, Seattle, WA 98195-7660, Mozambique

Background: Integrated Management of Childhood Illness (IMCI) training was given to a pilot group of primary-level health workers in Manica Province, Mozambique, in August 2001. Malaria is thought to be the leading cause of child mortality in this region. One year after training, we evaluated health worker adherence to IMCI protocols for evaluation of young children with fever. Methods: We observed 16 health workers (8 trained in IMCI, 8 controls) in their interactions with 161 sick children under 5 years of age whose chief complaint was fever. We compared health worker performance to norms defined by published IMCI algorithms. We also interviewed local health officials about health facility staffing, caseloads, pharmacy support, and laboratory capacity. Findings: Compared to their non-IMCI-trained counterparts, health workers trained in IMCI were more likely to: diagnose malaria, diagnose other conditions in addition to malaria, prescribe both antibiotics and antimalarials, and administer antibiotics and/or antimalarials prior to transfer of the sickest children. Health workers trained in IMCI diagnosed malaria in nearly every child they attended. Health workers trained in IMCI also spent more time with their patients. Overall adherence to IMCI algorithms was only fair. Adherence to protocol was better, and time spent with patients was longer, where health worker caseloads were lower. Conclusions: Health worker training in IMCI did appear to change health worker management of febrile children. However, clinical effectiveness of the IMCI fever algorithm may be limited in this setting by its poor specificity for malaria, and by very large health worker caseloads.

Learning Objectives:

After studying and/or discussing this abstract and supporting documentation, the participant in this session will be able to:
• List the 5 elements of the IMCI fever algorithm for which observed health-worker adherence was most problematic 1 year after initial training in IMCI.
• Describe 2 ways in which high health worker caseloads may adversely affect clinical effectiveness of IMCI fever algorithm.

Keywords: Child Health, Developing Countries

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.