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Health Research Policy and Systems

, 7:18

First Online: 17 July 2009Received: 10 February 2009Accepted: 17 July 2009DOI: 10.1186-1478-4505-7-18

Cite this article as: Goga, A.E., Muhe, L.M., Forsyth, K. et al. Health Res Policy Sys 2009 7: 18. doi:10.1186-1478-4505-7-18


BackgroundThe Integrated Management of Childhood Illness Strategy IMCI is effective in improving management of sick children, and thus child survival. It is currently recommended that in-service IMCI case management training ICMT occur over 11-days; that the participant: facilitator ratio should be ≤4:1 and that at least 30% of ICMT time be spent on clinical practice. In 2006–2007, approximately ten years after IMCI implementation, we conducted a multi-country exploratory questionnaire survey to document country experiences with ICMT, and to determine the acceptability of shortening duration of ICMT.

MethodsQuestionnaires QA were sent to national IMCI focal persons in 27 purposively-selected countries. To probe further, questionnaires QB and QC respectively were also sent to course-directors or facilitators and IMCI trainees, selected using snowball sampling after applying pre-defined criteria, in these countries. Questionnaires gathered quantitative and qualitative data.

ResultsThirty-three QA, 163 QB, 272 QC and two summaries were returned from 24 countries. All countries continued to adapt course content to local disease burden. All countries offer shorter ICMT courses, ranging from 3–10 days commonest being 5–8 days. The shorter ICMT courses offer fewer exercises, more homework, less individual feedback and reduced clinical practice <30% time. Whereas changes to course content were usually evidence-based, changes to training methodology and course duration evolved as pressure to expand implementation mounted. Participants varied in their self-reported skill and perception about each course. However, the varied methodology and integrated approach to management of illnesses were commonly cited as strengths of ICMT, and the chart booklet and clinical practice sessions were identified as critical components of ICMT. Four themes emerged from the qualitative work, viz. the current 11-day course is too expensive and should be shortened; advocacy around IMCI should increase; content should be regularly updated, new content areas should be introduced cautiously and more attention should be paid to skills-building rather than knowledge accumulation.

ConclusionWhilst the 11-day ICMT course is still recommended, as efforts intensify to increase access to quality care and meet MDG4, standardized shorter ICMT courses, that include participatory methodologies and adequate clinical practice, could be acceptable globally.

AbbreviationsThis paper uses the following abbreviationsARIAcute Respiratory Infection

CDDControl of Diarrhoeal Disease

IMCIIntegrated Management of Childhood Illness Strategy

ICMTIMCI Case Management Training

MDGMillennium Development Goals

NPOWHO National Programme Officer for IMCI

QAQuestionnaire A

QBQuestionnaire B

QCQuestionnaire C

UNICEFUnited Nations Children-s Fund

WHOWorld Health Organisation.

Electronic supplementary materialThe online version of this article doi:10.1186-1478-4505-7-18 contains supplementary material, which is available to authorized users.

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Autor: Ameena E Goga - Lulu M Muhe - Kevin Forsyth - Mickey Chopra - Samira Aboubaker - Jose Martines - Elizabeth M Mason


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