Integ Ted Management of Childhood Illness Betw En the Age of Two Months to Five Years

Objective: ~ evaluate the utility of the "WHO/UNICEF algorithm for integrated management of childhood illness ( IMCI) between the age of 2 months to 5 years. Design: Prospective observational. Set .ng: The Outpatient Department and Emergency Room of a medical collegehospital. Method: 203 children presenting to Outpatient Department (n=101 ) or Emergency Room (n=102) wer assessed and classified as per 'IMCI' algorithm and treatment required was identified. A etailed evaluation with all relevant investigations was also done for these subjects. The fin I diagnoses made and therapies instituted on this basis served as 'gold standard'. The diagnost c and therapeutic agreements between the 'gold standard' and the IMCI and vertical ( on the asis of primary presenting complaint) algorithms were computed. Results: More than one illn ss was present in 135 (66.5%) of subjects as per 'gold standard'. The mean (SD) numbers ofm rbidities as per the gold standard and IMCIlow and high malaria risks were 2.1 ( 1.1 ), 1.8 ( 1 .) and 2.2 ( 1. I ), respectively. Subjects having any referral criteria as per IMCI module had greater co-existence of illnesses (mean 2.6 vs. 1.6 illnesses per child, respectively). The r erral criteria proved useful in predicting hospitalization and a combination of hospitalizatio and observation; their sensitivity and specificity were 81% and 69% and 74% and 85%, res ectively. IMCI algorithms covered majority (92%) of the recorded illnesses. A total agreemen with IMCI (malaria low risk) was found in 129 (64%) cases while in 43 (22%) cases, there as partial agreement. Corresponding figures for vertical (split IMCI) program were 93 (460;1; r<0.001)and 41 (25%). The difference was primarily due to underdiagnoses (30%). Diagn stic discordance of 1MCI algorithm and gold standard was evidentfor the cough category due o underdiagnosis of bronchial asthma and bronchiolitis and an overdiagnosis of pneumonia w ereas the discordance for fever was due to an overdiagnosis ofmalaria. Identical results werefi undfor broad treatment categories. The IMCI algorithm had a provision for preventive servic s of immunization ( 16.3% possibility of availing missed opportunities) andfeeding advice. C nclusions: There is a sound scientific basis for adopting the IMCI approach since: (i) co-e istence of morbidities is frequent; (ii) severe illness is asses.~ed with good sensitiviiy and spec. Icity; and (iii) the IMCI algorithm is diagnostically and therapeutically superior to the vertical isease specific algorithms. The generic IMCI algorithm needs adaptation to refleci the regio al morbidity profile.