Health care for under-fives in Ile-Ife, South-West Nigeria: Effect of the Integrated Management of Childhood Illnesses (IMCI) strategy on growth and development of under-fives

Background: The study obtained information on key growth promotion and developmental household and community health practices in Community-Integrated Management of Childhood Illnesses (C-IMCI) and non-C-IMCI in local government areas (LGAs) in Osun State, Nigeria, to determine the differences that existed, between these LGAs. Method: A cross-sectional comparative study to compare Integrated Management of Childhood Illnesses (IMCI) key growth promotion and development health practices in two LGAs in Osun State was conducted using quantitative and qualitative techniques. Data analysis was done using Epi Info version 6.0 for the quantitative survey and a content analysis method for the qualitative survey. The subjects were mothers or caregivers of children 0–59 months of age, and their index children. Results: Findings revealed that the IMCI key growth and development health practices were generally better rated in the CIMCI-compliant LGA than in the non-CIMCI compliant LGA. Breastfeeding practice was widespread in both LGAs. However, the exclusive breastfeeding (EBF) rate among children under six months was higher in the compliant LGA (66.7%) than in the non-compliant LGA (25%). More caregivers (59.7%) from the non-compliant LGA introduced complementary feeds earlier than six months. Growth monitoring activities revealed that there were more underweight children (19.1%) in the non-compliant LGA. Community Resource Persons (CORPs) and health workers were the most popular sources of information on IMCI key practices in the compliant LGA, while in the non-compliant LGA the traditional healers, elders and, to a lesser extent, health workers provided information on these key practices. Conclusion: The IMCI strategy, if well implemented, is an effective and low-cost intervention that is useful in achieving optimal growth, development and survival of Nigerian children. INtRODUCtION The level of under-fi ve mortality in the less developed countries of the world, especially in sub-Saharan Africa, remains very high despite enormous investments in health system reforms and several vertical programmes.1 Each year almost 11 million children in lowand middle-income countries die before they reach their fi fth birthday.2 Five in 10 of these deaths are due to just fi ve conditions: malaria, pneumonia, diarrhoea, measles and HIV – often in combination.3 Malnutrition contributes to over 60% of these deaths.4 The Integrated Management of Childhood Illness (IMCI) is a strategy developed by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and other technical partners to address major child health problems in the developing world.5 IMCI seeks to address these problems through three intervention strategies – improved case-management, improved health systems support, and improved family and community practices. Success in reducing childhood mortality and in promoting optimal growth and development of children requires more than the availability of health services with well-trained health personnel. Since a major concern and responsibility of parents is caring for their children, success requires a partnership between health workers and families, and the support from their communities. Health workers in partnership with other developmental agencies need to work together with the families and solicit community support to ensure improved health practices for childcare at home, home treatment of mild illnesses with traditional non-harmful home remedies, timely recognition and prompt health care seeking when the child is sick, and compliance to the treatment.6 In 1996, Nigeria expressed willingness to implement the IMCI strategy and in 1997 gave a fi rm commitment to its adoption and implementation. In order to gain initial experience in IMCI implementation the government commenced with implementation of the fi rst two components in six local government areas (LGAs) spread across the country’s six geopolitical zones. Later, in 2005, the community component was implemented in the same LGAs. Community Resource Persons (CORPs) were trained to provide information about the key practices to caregivers and to ensure that they adopted the practices. This study obtained information on key growth and development household and community practices in C-IMCI and non-C-IMCI LGAs in Osun State, Nigeria, in order to determine what differences existed in these LGAs. Information derived will be useful to assess the achievement of the objectives of the community IMCI strategy over time. Information obtained may also be useful in advocating for expansion to other areas within Nigeria that are not yet C-IMCI compliant. MEtHOD Study sites: The study was conducted in one C-IMCI and one non-C-IMCI implemented LGAs in Osun State, Nigeria, between August and September 2007. Osun State is an inland state located in the southwestern zone of Nigeria. Its capital is Osogbo. Osun State, with a population of about 3.4 million,7 has 30 local government areas. Original Research Ebuehi Vol. 1 No. 1 Page PHCFM http://www.phcfm.org A fri ca n Jo ur na l o f P rim ar y H ea lth C ar e & F am ily M ed ic in e