The integrated management of childhood illness in western Uganda

Abstract

Bringing together various disease-specific guidelines for sick children, WHO and UNICEF have developed an Integrated Management of Childhood Illness (IMCI) algorithm, one component of which (assess and classify) was tested in the outpatient department of a rural district hospital in western Uganda. Children aged 2-59 months were seen first by a Ugandan medical assistant trained in IMCI, and then evaluated by a medical officer. Sensitivity, specificity and positive predictive values were determined by comparing the IMCI classifications with a reference standard based on the medical officers' diagnoses and laboratory tests. Of the 1226 children seen, 69% were classified into more than one symptom category, 7% were not classified in any symptom category, 8% had a danger sign, and 16% were classified into a severe category, for which the IMCI approach recommended urgent hospital referral. Specificity for most classifications was good, though sensitivity and positive predictive values were variable. We conclude that the IMCI algorithm is an important advance in the primary care of sick children in developing countries.

PIP: The World Health Organization (WHO) and UNICEF have developed the Integrated Management of Childhood Illness (IMCI) algorithm which incorporates the existing guidelines for the management of diarrhea and respiratory diseases, and adds new guidelines for measles, malaria, malnutrition, and anemia into one comprehensive case management approach. The assessment and classification component of the algorithm was tested in the outpatient department of a rural district hospital in western Uganda. 1226 children aged 2-59 months were first seen by a Ugandan medical assistant trained in IMCI, then evaluated by a medical officer. Sensitivity, specificity, and positive predictive values were determined by comparing the IMCI classifications with a reference standard based upon the medical officers' diagnoses and laboratory tests. 69% of the 1226 children seen were classified into more than one symptom category, 7% were not classified into any category, 8% had a danger sign, and 16% were classified into a severe category. The IMCI approach recommends that patients in this latter, severe category be urgently referred for hospital care. While specificity for most classifications was good, sensitivity and positive predictive values were variable. The IMCI algorithm is, however, an important advance in the primary care of sick children in developing countries.