The effect of training in Integrated Management of Childhood Illness (IMCI) on the performance and healthcare quality of pediatric healthcare workers: a systematic review

Abstract

Palavras-chave Atenção Integral às Doenças Prevalentes na Infância, Serviços de saúde da criança, Saúde da criançaprovided references for additional studies on IMCI, and unpublished articles of acceptable quality were included. The search covered the period from January 1993 (when IMCI was launched) to July 2006.Studies were included if they contained quantitative data comparing the performance of healthcare workers trained in IMCI to that of workers with no such training. Uncontrolled studies on the performance of health workers trained in IMCI were also eligible. Studies measuring the impact of IMCI on health indicators but not the performance of health workers were not included. Also excluded were studies using an exclusively qualitative methodology, manuals, technical information packs and reports providing no evaluation of the strategy.Analytical experimental or observational designs were included. The outcome parameters included performance indicators of health workers in evaluation, classification, treatment and counseling of mothers.Subsequently a critical evaluation of the selected articles was carried out, using the 27 quality criteria proposed by Downs and Black, including communication, external validity, internal validity (bias), internal validity (confounding factors) and statistical power. 6 These criteria relate to positive, partially positive or negative responses to questions on the methodological features of the article, such as whether the statistical tests used to measure the main results were adequate.The responses to the 27 quality criteria were entered into an Excel spreadsheet. A methodology score was used to indicate the quality of each article with regard to the strength of the evidence by dividing the number of positive items by the number of items evaluated.Data collection was carried out using an article extraction form requesting the following information: reference, key words, country, aims, outline, sample size, outcome, main results and comments. This last item included a brief analysis of the methodology and the implications of the study in terms of decision-making and future research.To facilitate the analysis, the articles were divided into: 1) preliminary studies on the IMCI algorithm; 2) studies with no external control group ("before and after" type) and 3) studies with an external control group.

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

“…In addition, users’ and community's perception of quality of healthcare20 47 and their past experiences,25 lack of effective interpersonal communication23 24 37 38 43 51 and poor relationship between providers and users38 52 were other important barriers. Power difference between users (women, parents and carers of children) and healthcare providers prevented active engagement of users in decision-making and was an important hurdle in patient and population engagement 30 53.…”

Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis

“…Despite nearly two decades since its inception, understanding the effects of IMCI on the diagnosis and equitable management of illnesses such as pneumonia and diarrhea remain key research priorities [13]. Early analyses including a systematic review by Amaral and Victora [14], which provided a narrative summary of algorithms and worker performance until 2006, concluded that training improved assessment, communication, and rational antibiotic use [15]. However, recent evaluations suggest that IMCI has fallen somewhat short of expectations given the low population coverage, fragmented health systems, and weak community health promotion [16], [17], [18], [19].…”

“…We extended the review by Amaral and Victora [14] by providing an updated literature synthesis and quantitative evaluation of performance, and we complemented the work by Rowe and colleagues [22] by examining the confounding effects of implementation adequacy, study design and methodological quality. We further assessed the contributions of these factors to heterogeneity, which is an expected element in meta-analyses of public health interventions [23].…”

Related factors to Integrated Management of Childhood illnesses at 18 Colombian Cities

“…On the one hand, the IMCI is a cost-effective strategy that improves the quality of health care using protocols on evidence-based medicine for the most common causes of morbidity and mortality in children under five (16). However, what is evident in this study are the low rates of integrated care reflecting the non-monitoring of the strategy in strict control by the regulatory bodies, as well as at Peru or Bolivia where it has not been properly carried out (12,17).…”