EVALUATION OF THE NUTRITIONAL COMPONENTS OF INTEGRATED MANAGEMNET OF CHILDHOOD ILLNESS (IMCI),PROGRAM IN ALEXANDRIA

Abstract

Adequate nutrition is a basic human need and a prerequisite during health and disease. The WHO and UNICEF, introduced approaches to combat childhood illness and to promote healthy growth and development of children. These efforts have resulted in the Integrated .. Management of Childhood Illness (IMCI) strategy that focuses on the child as a whole, rather than on a single disease or condition. IMCI has been introduced in Egypt under the umbrella of PHC in February 1997. It was introduced in Alexandria in October 1999 and by 2003 it was implemented in all primary health care facilities. The Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE), was coordinated by the Department of Child and Adolescent Health and Development (CAH) of the WHO. Evaluation of the nutritional component of the program can provide useful information that can help in improving the outcome of the program. In Egypt, few studies were conducted to evaluate the implementation of IMCI. None evaluated nutritional components in detail. The aim of the study was to evaluate the nutritional component of lMCI in Alexandria. It assessed the performance of health care providers applying the nutrition activities of IMCI and identified any gaps, problems or constraints in the implementation of the guidelines as perceived by the health providers and in the system. It also assessed the availability and adequacy of supplies, aids, equipment and training and identified the pattern of health and nutritional indicators under the umbrella of IMCI. Study setting and sample: The study was cross-sectional study and, it was carried out on: 24 physicians, 15 nurses applying the IMCI nutrition guidelines in health facilities and 120 sick children aged 2 months up to 5 years attending the health facilities during the study. The study was conducted in the health care facilities in East District in Alexandria: 2 MCH centers, 2 Family Health Units, 2 Urban Health centers, and one Hospital. Data collection methods: I. Interview of health care providers to collect personal data on qualification ; training on IMCI; other trainings; opinion about nutritional component of IMCI ; and obstacles encountered in using the guidelines and suggestions for improving services. Also, interview with manager of pharmacies was carried out to detect availability and adequacy of logistics and drugs. 2. Direct Observation to assess the performance of child health care providers in carrying out the nutrition activities during caring for sick children in the study setting. An observation checklist was used to collect data about health providers' compliance with the standard case management, based on the details of the various steps of difTerent aspects of care. Assessment performance on nurses in their tasks. Assessment performance of physicians in their tasks. Tasks were scored and the performance score was considered satisfactory when the sum was 70% and unsatisfactory if <70%. 3. Re- examination by the researcher: To determine if the cases were correctly assessed, classified and appropriate treatment was given.