Management of childhood illness in Africa

Early evaluations show promising results

The integrated management of childhood illness strategy (IMCI) has now been introduced into 28 countries in Africa. The strategy aims to improve the skills of health workers, the health system itself, and also the knowledge and practices of families in relation to their young children (see box).1 It has been operating for about three years, and most evaluations show positive results.

The strategy arose from criticism of disease specific control programmes like those targeted at diarrhoea and acute respiratory infections. Primary healthcare workers usually deal with children whose symptoms have overlapping causes and no single diagnosis. For example, cough and tachypnoea may be caused by pneumonia but also by severe anaemia or malaria. A “very sick” young infant may have pneumonia, septicaemia, and meningitis. Misclassification of illness by health workers is common: a study in Kenya showed that only 8% correctly diagnosed severe pneumonia.2

Component one of the strategy aims to improve health workers' performance by training them to use a clinical algorithm to detect the commonest causes of childhood illness (pneumonia, diarrhoea, malaria, measles, otitis media, and malnutrition) and by providing desktop guidelines for history taking and examination. Generic guidelines developed by the World Health Organisation are adapted by national experts in child health to take account of local epidemiology and to create versions of …