Rethinking the scale up of Integrated Management of Childhood Illness

Patel, Smruti; Zambruni, Jérôme Pfaffmann; Palazuelos, Daniel; Legesse, Hailemariam; Ndiaye, N; Detjen, Anne; Aboubaker, Samira

doi:10.1136/bmj.k2993

Cited by 4 publications

(4 citation statements)

References 14 publications

(18 reference statements)

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“…Egypt and Tanzania have successfully allocated a separate funding stream for IMCI within all district budgets to ensure sufficient and reliable funding of program activities [11]. The health system must also consider the importance of legitimacy and ownership at district level [58][59][60]. In Nepal and Democratic Republic of Congo (DRC), strengthening district health capacity has been an integral part in reaffirmation of IMCI and prevents donor-driven re-prioritization [58].…”

Section: Discussionmentioning

confidence: 99%

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Reñosa

Dalglish

Bärnighausen

et al. 2020

Global Health Action

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Background: Several evaluative studies demonstrate that a well-coordinated Integrated Management of Childhood Illnesses (IMCI) program can reduce child mortality. However, there is dearth of information on how frontline providers perceive IMCI and how, in their view, the program is implemented and how it could be refined and revitalized. Purpose: To determine the key challenges affecting IMCI implementation from the perspective of health care workers (HCWs) in primary health care facilities. Methods: A scoping review based on the five-step framework of Arskey and O'Malley was utilized to identify key challenges faced by HCWs implementing the IMCI program in primary health care facilities. A comprehensive search of peer-reviewed literature through PubMed, ScienceDirect, EBSCOhost and Google Scholar was conducted. A total of 1,475 publications were screened for eligibility and 41 publications identified for full-text evaluation. Twentyfour (24) published articles met our inclusion criteria, and were investigated to tease out common themes related to challenges of HCWs in terms of implementing the IMCI program. Results: Four key challenges emerged from our analysis: 1) Insufficient financial resources to fund program activities, 2) Lack of training, mentoring and supervision from the tertiary level, 3) Length of time required for effective and meaningful IMCI consultations conflicts with competing demands and 4) Lack of planning and coordination between policy makers and implementers resulting in ambiguity of roles and accountability. Although the IMCI program can provide substantial benefits, more information is still needed regarding implementation processes and acceptability in primary health care settings. Conclusion: Recognizing and understanding insights of those enacting health programs such as IMCI can spark meaningful strategic recommendations to improve IMCI program effectiveness. This review suggests four domains that merit consideration in the context of efforts to scale and expand IMCI programs.

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Section: Discussionmentioning

confidence: 99%

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Reñosa

Dalglish

Bärnighausen

et al. 2020

Global Health Action

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“…A separate cascade and measurement of effective coverage could be developed for each intervention; however, resource limitations in different contexts would make tracking of effective coverage of all interventions simul taneously impractical. When multi ple interventions are delivered through the same platform (eg, Integrated Management of Childhood Illness20 or Integrated Community Case Management21 ), selection of one intervention as a tracer for the overall contact might be appropriate.Quality-adjusted coverage was the preferred effective coverage measure for care of a sick child (acute or chronic illness), prevention of disease, and promotion of growth and development. This choice reflects the challenge of attributing contributions of several interventions to a single health outcome of child survival or wellbeing.…”

mentioning

confidence: 99%

Effective coverage measurement in maternal, newborn, child, and adolescent health and nutrition: progress, future prospects, and implications for quality health systems

Marsh

Muzigaba

Diaz

et al. 2020

The Lancet Global Health

116

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on behalf of the Effective Coverage Think Tank Group* Intervention coverage-the proportion of the population with a health-care need who receive care-does not account for intervention quality and potentially overestimates health benefits of services provided to populations. Effective coverage introduces the dimension of quality of care to the measurement of intervention coverage. Many definitions and methodological approaches to measuring effective coverage have been developed, resulting in confusion over definition, calculation, interpretation, and monitoring of these measures. To develop a consensus on the definition and measurement of effective coverage for maternal, newborn, child, and adolescent health and nutrition (MNCAHN), WHO and UNICEF convened a group of experts, the Effective Coverage Think Tank Group, to make recommendations for standardising the definition of effective coverage, measurement approaches for effective coverage, indicators of effective coverage in MNCAHN, and to develop future effective coverage research priorities. Via a series of consultations, the group recommended that effective coverage be defined as the proportion of a population in need of a service that resulted in a positive health outcome from the service. The proposed effective coverage measures and care cascade steps can be applied to further develop effective coverage measures across a broad range of MNCAHN services. Furthermore, advances in measurement of effective coverage could improve monitoring efforts towards the achievement of universal health coverage.

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“…Nuclear KIFC1 levels increase with increasing neoplastic progression and breast tumor aggressiveness. Specifically, KIFC1 expression has been demonstrated to be higher in basallike versus luminal breast cancers and higher in TNBCs versus non-TNBCs [21,36,[81][82][83]. Breast cancers in women of African descent develop at a significantly younger age, display a more aggressive disease course, and acquire more aggressive intrinsic subtypes, such as basal-like breast cancer and TNBC, compared to those in women of European descent.…”

Section: Luminal or Basal-like: Kifc1 And Intrinsic Subtype Specificationmentioning

confidence: 99%

Kinesin Family Member C1 (KIFC1/HSET): A Potential Actionable Biomarker of Early Stage Breast Tumorigenesis and Progression of High-Risk Lesions

Wright

Gong

Kittles

et al. 2021

JPM

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The enigma of why some premalignant or pre-invasive breast lesions transform and progress while others do not remains poorly understood. Currently, no radiologic or molecular biomarkers exist in the clinic that can successfully risk-stratify high-risk lesions for malignant transformation or tumor progression as well as serve as a minimally cytotoxic actionable target for at-risk subpopulations. Breast carcinogenesis involves a series of key molecular deregulatory events that prompt normal cells to bypass tumor-suppressive senescence barriers. Kinesin family member C1 (KIFC1/HSET), which confers survival of cancer cells burdened with extra centrosomes, has been observed in premalignant and pre-invasive lesions, and its expression has been shown to correlate with increasing neoplastic progression. Additionally, KIFC1 has been associated with aggressive breast tumor molecular subtypes, such as basal-like and triple-negative breast cancers. However, the role of KIFC1 in malignant transformation and its potential as a predictive biomarker of neoplastic progression remain elusive. Herein, we review compelling evidence suggesting the involvement of KIFC1 in enabling pre-neoplastic cells to bypass senescence barriers necessary to become immortalized and malignant. We also discuss evidence inferring that KIFC1 levels may be higher in premalignant lesions with a greater inclination to transform and acquire aggressive tumor intrinsic subtypes. Collectively, this evidence provides a strong impetus for further investigation into KIFC1 as a potential risk-stratifying biomarker and minimally cytotoxic actionable target for high-risk patient subpopulations.

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Rethinking the scale up of Integrated Management of Childhood Illness

Abstract: The global community must come together to rethink approaches and translate existing knowledge into action, say Smruti Patel and colleagues

Cited by 4 publications

References 14 publications

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Effective coverage measurement in maternal, newborn, child, and adolescent health and nutrition: progress, future prospects, and implications for quality health systems

Kinesin Family Member C1 (KIFC1/HSET): A Potential Actionable Biomarker of Early Stage Breast Tumorigenesis and Progression of High-Risk Lesions

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