Unresolved Issues in Implementing Integrated Management of Childhood Illness (IMCI) Approach.

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Date: May 2021
Publisher: Kerman University of Medical Sciences
Document Type: Article
Length: 1,110 words
Lexile Measure: 1950L

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Dear Editor,

Debate has been continuing for the implementation for Integrated Management of Childhood Illnesses (IMCI) strategy on childhood pneumonia to curve under-5 mortality in low- and middle-income countries (LMICs). Recent systematic reviews are still divided into both positives (1,2) and negatives (3) on the effectiveness of training and supportive supervision. (4) IMCI approach itself has been going through several revisions in clinical signs (5) and more recent evidences came out to suggested none of the clinical signs were sufficiently reliable to diagnose childhood pneumonia. (6) Current debates are how to employ point-of-care pulse oximetry (Pox) in IMCI approach to improve the detection of hypoxia. (7) The new technology itself, however, is not necessarily a panacea: Literature (8) showed low current knowledge and usage of Pox at both district hospitals and healthcare posts. (9) And my recent observation (10) concurs the argument that Pox itself needs to be revised as a reliable, easy to use device at the bedside. (11) All of these discussions, mixed results on training in LMICs, the development of new technology, and my recent observations, are all reminiscent of the fact that IMCI approach for childhood pneumonia is at chasm.

More than 10 years ago, we looked at the referral pattern and the initial care seeking behavior among remote six districts in Quetzaltenango, Guatemala where we implemented IMCI training among community healthcare workers recruited by the government for two consecutive years.

We interviewed family members of deceased children in the project area to figure out where they first looked for help. Less than fifth of them (17% in 2006 and 12% in 2007) sought initial care in government-run healthcare facilities. In fact, in...

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Gale Document Number: GALE|A662078020