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Integrated Management of Childhood Illness (IMCI) Strategy for Children Under Five

More than 7.5 million children worldwide die each year before they reach the age of five. Most of them come from poor communities and live in the poorest countries. These children are more likely than others to suffer from malnutrition and from infectious diseases such as neonatal sepsis, measles, diarrhea, malaria and pneumonia.

Effective strategies for the prevention and treatment of sick children are available, but do not reach them. One reason for this is that medical services are often too far away or too expensive. Medical institutions in these conditions are often insufficiently equipped and do not have well-trained medical personnel. In addition, sick children can have several diseases at the same time, and this can cause difficulties for health workers in the diagnosis and treatment.

In the 1990s, the World Health Organization (WHO) developed a strategy called Integrated Management of Childhood Illness (IMCI) to address these challenges. This strategy is aimed at preventing death and disease and at the same time improving the quality of medical care for sick children under the age of five. It consists of three parts.

• Continuing education for health workers through training and guidelines (clinical guidelines).

• Improving the organization and management of health systems, including access to supplies.

• Visiting homes and communities to introduce proper parenting and nutrition practices, while encouraging parents to bring their children to the clinic when the children become ill.

WHO encourages countries to adapt IMCI strategies to suit their national circumstances. Priority childhood illnesses and methods of care may vary by country.

What are the main results of this review?

This Cochrane review includes four studies evaluating the effectiveness of an IMCI strategy. These studies have been conducted in Tanzania, Bangladesh and India. The IMCI strategy has been used differently in different studies. For example, a study from Tanzania trained health workers and improved drug supplies, but did not include home visits or social events; a study from Bangladesh introduced new health workers while training existing health workers; and two Indian studies specifically targeted newborns as well as older children.

This review showed that the use of IMCI:

• may result in fewer deaths of children from birth to five years (low confidence in evidence);

• may have little or no effect on the number of children with stunted growth (low confidence in evidence);

• likely to have little or no effect on the number of children suffering from malnutrition (moderate confidence in evidence);

• likely to have little or no effect on the number of children receiving measles vaccine; and

• May lead to mixed results regarding the effect on the number of parents seeking help for their child when he or she is sick.

We don’t know if any of the IMCIs affects how healthcare providers treat common diseases because confidence in the evidence was rated as very low.

We do not know whether IMCI has any influence on the number of mothers who exclusively breast-feed their children, because the confidence in the evidence was rated as very low.

None of the studies included evaluated the satisfaction of mothers and other users of the IMCI strategy.

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