ASSESSMENT OF THE EFFECT OF IMPLEMENTATION OF THE INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) APPROACH ON CHILDCARE IN KANO STATE NIGERIA

Abstract

Introduction: The study obtained information on health care workers skills, assessed the health system for provision of quality child care services and key household and community practices in IMCI implementing and non implementing communities in 2 local government areas (LGAs) of Kano State, Nigeria, to determine the differences that existed, between these LGAs.
Methodology: Using a comparative study design, two LGAs one implementing IMCI and the other not implementing IMCI were studied. Consultations with sick children under 5 years old at facilities in two IMCI implementing and two comparison districts were observed. Children’s caretakers and health workers were interviewed, and children were re-examined by a ‘gold standard’ study clinician. Fifty two IMCI trained health workers were observed in two health facilities and compared with 40 non IMCI trained health workers; (92 consultations were observed). The community component observed and compared key community and household practices between the two LGAs in Kano State. The subjects were caregivers of children 0–59 months of age, and their index children selected using a multi stage cluster sampling. The study was conducted between February 2009 – January 2010. Data analysis was done using Epi Info version 6.0 and minitab softwares.
Result. In many cases health workers used IMCI chart booklet to assess presenting symptoms but did not implement IMCI comprehensively. Almost all 50/52 (96.2%) health workers in IMCI health facilities referred to IMCI guidelines during the period of observation. Majority of observed health workers 42/52 (80.1%) checked general danger signs in every child in IMCI facility compared to 22.5% in non IMCI facility. Three quarter of (75%) children with severe classifications were correctly identified by IMCI health workers. Nutritional status was correctly identified and classified as low weight in 10/52(19.2%) of children attending IMCI facilities. More caregivers were also observed to leave IMCI facility better informed on child’s condition (73%) compared to caregivers attending comparison facility (53%). Findings revealed that the IMCI key household and community practices were generally better in the IMCI-implementing communities than in the non-IMCI communities. Exclusive breastfeeding (EBF) rate among children under six months was higher in the IMCI communities (23.2%) than in the non-IMCI (6.1%). More caregivers (75%) from the non-IMCI communities introduced complementary feeds earlier than six months and that there were more underweight children (31.5%) in the non-IMCI community. Community Resource Persons (CORPs) and health workers were main sources of information on IMCI key practices in the IMCI community.
Conclusion IMCI is seen to have a positive impact on the performance of health care workers, the strengthening of the health system by having more drugs and supplies as well as empowering the caregivers to have improved child care services at home. It is recommended IMCI should be expanded to other LGAs and communities.

ASSESSMENT OF THE EFFECT OF IMPLEMENTATION OF THE INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) APPROACH ON CHILDCARE IN KANO STATE NIGERIA