Evaluation of the WHO/UNICEF algorithm for integrated management of childhood illness

Abstract

Background: The present study was designed to evaluate the feasibility and utility of the integrated management of the childhood illness (IMCI) algorithm to diagnose the illnesses in children under the age of 2 months to 5 years.Methods: The study was conducted on 300 children, aged 2 months to 5 years, who presented with a fresh episode of any illness to the out-patient Department of the SMGS Hospital over a period of 9 months. Within these initial selection criteria, the WHO/UNICEF algorithm for management of the sick child was referred to, children were assessed and classified as per "IMCI" algorithm and treatments required were identified. The final diagnosis was made and appropriate therapy instituted served as the "Gold standard". The diagnostic and therapeutic agreements between the 'gold standard' and the IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed.Results: Among all 300 subjects, more than one illness was present in 207 (69%) of subjects as per Gold standard diagnosis. The corresponding, figures for IMCI module were 141 (47%) and 222 (74%) for low and high malaria algorithms respectively. The mean illnesses per child were 2.12, 182 and 2.21, respectively. The subjects who would have been referred as per IMCI module had a greater co-existence of illnesses than those who would not have been referred (mean 2.5 versus 1.5 illnesses per child respectively). The specificity for general danger signs was 66% while the sensitivity was 71%.Conclusions: In conclusion, the performance of the IMCI algorithm is significantly better than the vertical disease specific algorithm. In addition, the IMCI algorithm incorporates an element of preventive care in the form of immunization and feeding advice.