Class act – IMCI training boosts health workers’ performance

Antimicrobial drugs are an essential tool for child survival, treating major killers such as pneumonia, diarrhoea and malaria. But antibiotic misuse by health workers is adding to the rise in drug-resistant disease. Training primary health workers in Integrated Management of Childhood Illnesses (IMCI) can improve the use of antimicrobials for children.

IMCI is a strategy developed by WHO and UNICEF to provide effective and affordable ways to reduce child mortality and improve child health and development. IMCI includes both prevention and treatment, and is designed to:

• develop the case-management skills of health workers
• strengthen health system support for child health service delivery
• improve family and community practices relating to child health.

Health workers in more than 100 developing countries have received in-service or pre-service training in IMCI case management. The training guides the health worker through a process of assessing signs and symptoms, classifying the illness based on treatment needs and providing suitable treatment and education of the child’s caregiver. But does it have an impact on antimicrobial use at the primary level?

Researchers from the World Health Organisation surveyed 75 health facilities in Tanzania, 80 in Uganda and 96 in north-eastern Brazil. They found that about one-third of children under five years visiting health facilities in Tanzania and Uganda are classified as needing antibiotics. Most of these have pneumonia; others have acute ear infections or dysentery. More than two thirds of children in these countries are given anti-malarials. In Brazil, 10 percent of children require antibiotics – 28 percent of them for pneumonia, 18 percent for acute ear infection and 68 percent for other infections.

The surveys also showed that, compared with their colleagues, IMCI-trained health workers are more likely to:

• prescribe anti-malarials and antibiotics correctly
• communicate effectively to caregivers about how these drugs should be used
• provide the first dose of the drug at the health facility, ensuring that treatment begins promptly and caregivers see how to give it correctly
• promote rational use of these drugs, with fewer children receiving unnecessary antibiotics.

The researchers conclude that Ministries of Health and their partners, including WHO, should support IMCI case-management training, not only to improve management of childhood illness but also to reduce the misuse of antimicrobials. They list some of the challenges involved for developing countries, including:

• increasing training coverage at primary level facilities, given the rapid turnover of staff in some settings
• incorporating IMCI guidelines into pre-service training of health workers
• improving care-seeking behaviour
• strengthening the roles of community-based health workers.

Source(s):
‘Improving antimicrobial use among health workers in first-level facilities: results from the Multi-Country Evaluation of the Integrated Management of Childhood Illness strategy’, Bulletin of the World Health Organization 82: 509-515, by E. Gouws et al, 2004 Full document.

Funded by: World Health Organisation; Bill and Melinda Gates Foundation; USAID; United Republic of Tanzania Ministry of Health; International Development Research Centre, Canada

id21 Research Highlight: 19 April 2005

Further Information:
Eleanor Gouws
Social Mobilization and Information Department
UNAIDS
20 Avenue Appia
1211 Geneva 27

Contact the contributor: gouwse@unaids.org

World Health Organisation

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'Coverage story: how to deliver better child survival'

'Managing childhood illness: how effective is IMCI in Tanzania?'

'Young, poor and sick: socioeconomic inequities and child health in rural Tanzania'

'Danger in disguise – spotting the warning signs of severe childhood illnesses'

'Decisions, decisions – adapting the IMCI approach for Kenyan paediatric hospitals'

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