Impact of implementation of Integrated Management of Childhood Illness on improvement of health system in China

Zhang, Yanfeng; Dai, Yaohua; Zhang, Shuaiming

doi:10.1111/j.1440-1754.2007.01187.x

Cited by 25 publications

(22 citation statements)

References 1 publication

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“…[74][75][76][77][78][79][80][81][82][83]85 In low-income to medium-income countries, training of health-care workers as part of WHO's Integrated Management of Childhood Illness strategy has been shown to increase appropriate use of antimicrobials and decrease inappropriate use. [122][123][124][125] Non-physician health-care workers trained in integrated management of childhood illness might use antimicrobials more judiciously than physician providers. In resource-limited settings, training of nonphysician providers could increase both access to and appropriate use of antimicrobials; this is especially important in regions where inadequate numbers of physician providers could drive non-prescription antimicrobial use.…”

Section: Discussionmentioning

confidence: 99%

Non-prescription antimicrobial use worldwide: a systematic review

Morgan

Okeke

Laxminarayan

et al. 2011

The Lancet Infectious Diseases

771

670

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In much of the world antimicrobial drugs are sold without prescription or oversight by health-care professionals. The scale and effect of this practice is unknown. We systematically reviewed published works about non-prescription antimicrobials from 1970-2009, identifying 117 relevant articles. 35 community surveys from five continents showed that non-prescription use occurred worldwide and accounted for 19-100% of antimicrobial use outside of northern Europe and North America. Safety issues associated with non-prescription use included adverse drug reactions and masking of underlying infectious processes. Non-prescription use was common for non-bacterial disease, and antituberculosis drugs were available in many areas. Antimicrobial-resistant bacteria are common in communities with frequent non-prescription use. In a few settings, control efforts that included regulation decreased antimicrobial use and resistance. Non-prescription antimicrobial and antituberculosis use is common outside of North America and northern Europe and must be accounted for in public health efforts to reduce antimicrobial resistance.

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Section: Discussionmentioning

confidence: 99%

Non-prescription antimicrobial use worldwide: a systematic review

Morgan

Okeke

Laxminarayan

et al. 2011

The Lancet Infectious Diseases

771

670

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“…China outperformed most of the 74 Countdown to 2015 countries (countries with high under-5 mortality rate, large numbers of under-5 deaths, or both) in its progress on major infectious causes, such as pneumonia and diarrhoea 25 . Improved socioeconomic status, water, sanitation, nutrition, and access to integrated management of childhood illness could be contributors to success 10, 26, 27. Major causes of neonatal mortality, such as preterm birth complications and intrapartum-related events, have also been steadily declining, which might be associated with increased quality of institutional delivery and neonatal resuscitation 28, 29.…”

Section: Discussionmentioning

confidence: 99%

National and subnational all-cause and cause-specific child mortality in China, 1996–2015: a systematic analysis with implications for the Sustainable Development Goals

Liu

Chu

et al. 2017

The Lancet Global Health

148

131

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SummaryBackgroundChina has achieved Millennium Development Goal 4 to reduce under-5 mortality rate by two-thirds between 1990 and 2015. In this study, we estimated the national and subnational levels and causes of child mortality in China annually from 1996 to 2015 to draw implications for achievement of the SDGs for China and other low-income and middle-income countries.MethodsIn this systematic analysis, we adjusted empirical data on levels and causes of child mortality collected in the China Maternal and Child Health Surveillance System to generate representative estimates at the national and subnational levels. In adjusting the data, we considered the sampling design and probability, applied smoothing techniques to produce stable trends, fitted livebirth and age-specific death estimates to natvional estimates produced by the UN for international comparison, and partitioned national estimates of infrequent causes produced by independent sources to the subnational level.FindingsBetween 1996 and 2015, the under-5 mortality rate in China declined from 50·8 per 1000 livebirths to 10·7 per 1000 livebirths, at an average annual rate of reduction of 8·2%. However, 181 600 children still died before their fifth birthday, with 93 400 (51·5%) deaths occurring in neonates. Great inequity exists in child mortality across regions and in urban versus rural areas. The leading causes of under-5 mortality in 2015 were congenital abnormalities (35 700 deaths, 95% uncertainty range [UR] 28 400–45 200), preterm birth complications (30 900 deaths, 24 200–40 800), and injuries (26 600 deaths, 21 000–33 400). Pneumonia contributed to a higher proportion of deaths in the western region of China than in the eastern and central regions, and injury was a main cause of death in rural areas. Variations in cause-of-death composition by age were also examined. The contribution of preterm birth complications to mortality decreased after the neonatal period; congenital abnormalities remained an important cause of mortality throughout infancy, whereas the contribution of injuries to mortality increased after the first year of life.InterpretationChina has achieved a rapid reduction in child mortality in 1996–2015. The decline has been widespread across regions, urban and rural areas, age groups, and cause-of-death categories, but great disparities remain. The western region and rural areas and especially western rural areas should receive most attention in improving child survival through enhanced policy and programmes in the Sustainable Development Goals era. Continued investment is crucial in primary and secondary prevention of deaths due to congenital abnormalities, preterm birth complications, and injuries nationally, and of deaths due to pneumonia in western rural areas. The study also has implications for improving child survival and civil registration and vital statistics in other low-income and middle-income countries.FundingBill & Melinda Gates Foundation.

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“…Another study in South Africa found improvements in assessment of danger signs in sick children, rational prescribing, and initiation of treatment in the clinic following IMCI introduction [16]. In China, inappropriate prescription was shown to decrease from 44% to 3% for injection drugs, and from 60% to 6% for antibiotics after IMCI implementation [17]. In Morocco, correct prescription of antibiotics was also shown to significantly improve by nearly 30% [18].…”

Section: Morbidity Mortality and Health Service Quality Improvementsmentioning

confidence: 99%

“…One study in China found that availability of children's scales increased from 28% to 91%, timing devices from 89% to 97%, and utilities for mixing oral rehydration salts from 37% to 100% with the introduction of IMCI [17]. The same study also noted a significant increase in supply of all recommended drugs, vitamins, tetracycline eye ointment, and diazepam.…”

Section: Equipment and Suppliesmentioning

confidence: 99%

National implementation of Integrated Management of Childhood Illness (IMCI): Policy constraints and strategies

2010

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Impact of implementation of Integrated Management of Childhood Illness on improvement of health system in China

Abstract: The IMCI strategy has been shown to contribute to the improvement of the health system, promoting the efficient management of medical care at township and village level, as well as improving the relationship between doctors and patients.

Cited by 25 publications

References 1 publication

Non-prescription antimicrobial use worldwide: a systematic review

Non-prescription antimicrobial use worldwide: a systematic review

National and subnational all-cause and cause-specific child mortality in China, 1996–2015: a systematic analysis with implications for the Sustainable Development Goals

National implementation of Integrated Management of Childhood Illness (IMCI): Policy constraints and strategies

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