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DETERMINANTS OF USE OF IMCI GUIDELINES IN MANAGEMENT OF CHILDHOOD ILLNESS AMONG HEALTH WORKERS IN SELECTED PHC


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Abstract

Several evaluative studies demonstrate that a well-coordinated Integrated Management of Childhood Illnesses (IMCI) program can reduce child mortality. The Integrated Management of Childhood Illness (IMCI) is a child health strategy developed by the World Health Organization and UNICEF aimed at reducing child morbidity and mortality. This study aimed to determining the effectiveness of the use of IMCI guidelines in management of childhood illness among health workers in selected      settings and to resensitize them about reduction of infant morbidity and mortality rates through IMCI implementation. However, there is dearth of information on how frontline providers perceive IMCI and how, in their view, the program is implemented and how it could be refined and revitalized. The study adopt the survey research design for the study, the population of the study comprise of 300 patient and staff of primary health center (PHC) in Potiskum LGA of Yobe State. The method of data analysis was the percentage, graphical and chi-square statistics. At the completion of the study it was concluded that d understanding insights of those enacting health programs such as IMCI can spark meaningful strategic.

 

CHAPTER ONE

INTRODUCTION

  • Background of the study

The Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy is an integrated approach to child health that holistically focuses on the well-being of the whole child. The IMCI strategy aims to reduce illness, disability, and death, and to promote improved growth and development among children under 5 years of age. The strategy includes both preventive and curative elements that are implemented by families, communities, and health care facilities (WHO, 2015). Implementation of integrated management of childhood illness (IMCI) in comprehensive and holistic approach that forms bench mark for basic child health in promoting celebration of fifth birth day for children below five years of age, free from Malaria, Pneumonia, Diarrhea, Measles and Malnutrition (Ketsela, Tigest, P. Habimana, M. Jose, M. Andrew, and W. Abimbola, 2016). The Integrated Management of Childhood Illness (IMCI) remains the cornerstone for child survival strategies and for improving the quality of care provided to sick children in health facilities in over 100 countries (WHO 2019). Every year some 12 million children in developing countries die before they reach their fifth birthday. Seven in ten of these deaths are due to acute respiratory infections (mostly pneumonia), diarrhea, measles, malaria or malnutrition. ­e WHO Department of Child and Adolescent Health and Development (CAH), in collaboration with eleven other WHO programmes and UNICEF, has responded to this challenge by developing the Integrated Management of Childhood Illness (IMCI) strategy (WHO 2014). Th­e main objectives of the strategy are to reduce death and the frequency and severity of illness and disability, and to contribute to improved growth and development (FMOH, 2016).  Integrated Management of Childhood Illness (IMCI) remains key strategy to reducing child mortality. ­e strategy includes improving case management skills of sick children at first level health facilities, strengthening health system and improving family and community to promote child health. In Africa region, 22 countries are now implementing IMNCI in over 75% of districts, compared with only 10 countries in 2007 (WHO 2010). Ethiopia has one of the highest under-five mortality rates with more than 321,000 children under the age of five dying every year. As children usually present with more than one of the preventable disease conditions, it was recognized that there was need for an integrated approach in order to manage the child in a holistic manner. ­is led to the development of IMNCI strategy which integrates all available measures for health promotion, prevention and integrated management of childhood diseases through their early detection and effective treatment, and promotion of healthy habits within the family and community (Adekanye and T. D. Odetola 2014). ­e importance of having an Integrated Management of Newborn and Childhood Illness strategy is that it enables a consistent and standardized approach that addresses the major causes of under-five morbidity and mortality which are responsible for more than 90% of the mortality in this age group in Nigeria (M. B. Silali, 2014). ­The strategy includes three main components: Improvements in the case-management skills of health staff through the provision of locally adapted guidelines on IMCI and through activities to promote their use. Improvements in the health system required for effective management of childhood illness. Improvements in family and community practices (Adekanye and T. D. Odetola 2014). Projections based on the 1996 analysis the global burden of disease indicate that these conditions will continue to be major contributors to child deaths in the year 2020 unless significantly greater efforts are made to control them. Every day, millions of parents take children with potentially fatal illnesses to first-level health facilities such as clinics, health centres and outpatient departments of hospitals. In some countries, three in four episodes of childhood illness are caused by one of these five conditions. And most sick children present with signs and symptoms related to more than one. This overlap means that a single diagnosis may not be possible or appropriate, and that treatment may be complicated by the need to combine therapy for several conditions. Surveys of the management of sick children at these facilities reveal that many are not properly assessed and treated and that their parents are poorly advised. At this level, in most developing countries, diagnostic supports such as radiology and laboratory services are minimal or non-existent; and drugs and equipment are scarce. Limited supplies and equipment, combined with an irregular flow of patients, leave health care providers at first-level facilities with few opportunities to practise complicated clinical procedures. Instead, they must often rely on history and signs and symptoms to determine a course of management that makes the best use of available resources (WHO, CAH 2007).

  • STATEMENT OF THE PROBLEM

Several studies conducted in different countries indicated that the implementation of the IMNCI strategy is still inadequate. Th­ese studies also mentioned a variety of factors that influences the implementation of the strategy by health workers. Th­e most common identified problems are lack of training, poor supervision, lack of IMNCI essential drugs and on jobs aid, health workers perception, shortage of the staffs, nature of the strategy and lack of support from the government and stake holders (Mupara, L. M. 2013). Every day about 16,000 under five children continue to die in 2015, most of them will perish from preventable causes, such as pneumonia, diarrhea and malaria (Federal Ministry of Health 2019). Annually 1.12 million neonatal deaths occur in the African region which accounts quarter of all under five deaths. Half of these deaths occur in just five countries-Ethiopia, Nigeria, Democratic Republic of Congo, United Republic of Tanzania and Uganda. Saving these lives would take and estimated extra US $1.39 per capita per year. It is also estimated that every minute eight under five children die in sub-Saharan Africa. Two third of this deaths occurs due preventable cause of deaths such as pneumonia 21%, malaria 18%, diarrheal diseases 16%, measles 5% and HIV/AIDS 6% most of which complicated by malnutrition that accounts one third of all deaths in children under five years (WHO, 2007). Recent reports indicate that neonatal mortality, infant mortality and under-5 mortality stand at 37, 59 and 67, respectively per 1000 live births (Human National Development Report, 2014). Although Ethiopia has achieved Millennium Developmental Goal MDG 4 targets of reducing child mortality and witnessed a steady reduction in child mortality (more than 40%) across the country, over 300,000 children under the age of five still die each year from preventable or treatable conditions such as diarrhea, ARI primarily pneumonia, and malaria, neonatal problem in combination with malnutrition (Snow 2018). IMCI coverage was 20% for other LGA, 4% for Potiskum LGA of Yobe, and 25% for other Region. ­The percentage of trained targeted health workers in the three regions was even lower than the IMCI coverage. ­The proportion of under-five cases assessed by IMCI trained health workers ranged from 0% in Potiskum LGA, to 16% in other and 32% in North central (Snow 2018). Regarding the factors that influences IMNCI implementation this survey also revealed that Consultation time was lower than recommended by IMCI guidelines (15–20 minutes) although it was higher for IMCI trained health workers (13 minutes in average). Supplies were available for most health facilities but there was inadequate supervision. ­e integrated index of assessment was on average 0.42 of the recommended 10 variables. Most children were not checked for general danger signs, nutritional status or vaccination. ­ere was over classification of pneumonia and under classification of malaria in all three regions and the percentage of children treated correctly was low (Snow 2018). A variety of efforts has been made by the government of Ethiopia In attempt to overcome this problem and further reduce child mortality rate. For example trying to increase the cumulative number of Health centers (HC) providing Integrated management of neonatal and childhood illness and training Health Extension Workers (HEWs) on the issues to manage childhood illness at community level, however the implementation of the  IMNCI strategy may get hampered by many challenges (Goga and L. M. Muhe, 2011).

  • OBJECTIVE OF THE STUDY

The study has one main objective which is subdivided into general and specific objective, the general objective is to determine the use of IMCI guidelines in management of childhood illness among health workers in selected public health center in Potiskum LGA of Yobe State. The specific objectives are;

  1. To examine the effect of IMCI guideline in combatting childhood illness among health worker in Potiskum LGA
  2. To ascertain if there is any significant relationship between IMCI guideline and reduction in childhood illness in public health centers
  • To examine the role of public health center workers in ensuring compliance with IMCI guideline
  1. To appraise the role of government in ensuring compliance with IMCI guideline in Potiskum LGA Yobe State
    • RESEARCH QUESTIONS

The following research questions were formulated by the researcher to aid the completion of the study;

  1. Does IMCI guideline has any effect in combatting childhood illness among health worker in Potiskum LGA?
  2. Is there any significant relationship between IMCI guideline and reduction in childhood illness in public health centers?
  • Does public health center workers play any role in ensuring compliance with IMCI guideline?
  1. Does government play any role in ensuring compliance with IMCI guideline in Potiskum LGA Yobe State?

 

  • RESEARCH HYPOTHESES

The following research hypotheses were formulated by the researcher in null and alternate form to aid the completion of the study;

H0: There is no significant relationship between IMCI guideline and reduction in childhood illness in public health centers

H1: There is a significant relationship between IMCI guideline and reduction in childhood illness in public health centers

H0: government does not play any role in ensuring compliance with IMCI guideline in Potiskum LGA Yobe State

H2: government does play a role in ensuring compliance with IMCI guideline in Potiskum LGA Yobe State

  • SIGNIFICANCE OF THE STUDY

During this time, the IMNCI strategy has an important role in reduction of child mortality and morbidity. In Potiskum LGA the study conducted on determinants of use of IMCI guideline in management of childhood illness among health workers in public health centers in Yobe state. Th­erefore this study seeks to assess the factors influencing the implementation of IMNCI strategy by the nurses in in Pottiskum LGA. ­therefore, firstly the data from this study will be useful to health planners such as those responsible bodies working on integrated management of neonatal and child hood illness and will also enable such bodies to design better programs to address the identified problems. Secondly the study findings will be useful for the community in reduction of under-five mortality and morbidity. Lastly, this paper will be used as important literature for future researchers who want to undertake similar study.

  • SCOPE AND LIMITATION OF THE STUDY

The scope of the study covers determinants of use of IMCI guidelines in management of childhood illness among health workers in selected PHC in Potiskum LGA of yobe state. In the course of the study, there were some factors that limit the scope of the study;

  1. a) AVAILABILITY OF RESEARCH MATERIAL: The research material available to the researcher is insufficient, thereby limiting the study
  2. b) TIME: The time frame allocated to the study does not enhance wider coverage as the researcher has to combine other academic activities and examinations with the study.
  3. c) Organizational privacy: Limited Access to the selected auditing firm makes it difficult to get all the necessary and required information concerning the activities.

1.8 OPERATIONAL DEFINITION OF TERMS

IMCI

Integrated Management of Childhood Illness (IMCI) is a systematic approach to children's health which focuses on the whole child.

Childhood illness

Childhood illness and disorder, any illness, impairment, or abnormal condition that affects primarily infants and children those in the age span that begins with the fetus and extends through adolescence

PHC

Primary health care, or PHC, refers to “essential health care” that is based on scientifically sound and socially acceptable methods and technology

Health workers

A healthcare worker is one who delivers care and services to the sick and ailing either directly as doctors and nurses or indirectly as aides, helpers, laboratory technicians, or even medical waste handlers.

1.9 ORGANIZATION OF THE STUDY

This research work is organized in five chapters, for easy understanding, as follows

Chapter one is concern with the introduction, which consist of the (overview, of the study), statement of problem, objectives of the study, research question, significance or the study, research methodology, definition of terms and historical background of the study. Chapter two highlight the theoretical framework on which the study its based, thus the review of related literature. Chapter three deals on the research design and methodology adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding.  Chapter five gives summary, conclusion, and recommendations made of the study.

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Author: SPROJECT NG