Evaluation of the Integrated Management of Childhood Illness Strategy Implementation in Bulawayo City, Zimbabwe, 2006

Abstract

Introduction: Bulawayo City reported an age-specific death rate of 5.9/1000 in 2004 in under fives and this rose to 6.8/1000 in 2005. Nurses were trained in the implementation of Integrated Management of Childhood Illness (IMCI) in 2005. We evaluated the programme in order to establish the level of implementation and hence the quality of care being given to children under five years.
Methods: We used a cross-sectional study design. The study population comprised of sick children aged two months to five years, health care workers and caregivers .Data was collected using a structured observation checklist of the case management of sick children, exit interview with caregivers, and a structured inventory checklist for equipment, drugs, and supplies in the facility.
Results: Seventy-two children were observed during management. Seventeen (24%) were checked for three general danger signs, thus failure to drink or breastfeed, vomiting everything and convulsions, 31(43%) were correctly prescribed an oral antibiotic and 11% received the first dose of treatment at the health facility. Thirty-two percent of caretakers who received a prescription for an oral medication correctly reported on how to give the treatment. Drugs were below minimum stock levels in all nine facilities. Of the 94 nurses responsible for management of children only 19(20%) were trained in IMCI.
Conclusion: In Bulawayo, IMCI implementation failed to meet the standard IMCI protocol requirements. Of note was that IMCI trained health workers are dispersed throughout the facilities and hence have little synergistic effect to impact on how sick children are managed.