Evaluation of the Integrated Management of Childhood Illness strategy implementation in Bulawayo City, Zimbabwe, 2006

Introduction. Bulawayo City reported an age-specific death rate for under-5s of 5.9/1 000 in 2004, and this figure rose to 6.8/1 000 in 2005. Nurses were trained in implementation of the Integrated Management of Childhood Illness (IMCI) strategy in 2005. We evaluated the programme in order to establish the level of implementation and the quality of care given to children aged under 5 years. Methods. We conducted a cross-sectional study on a population of sick children aged between 2 months and 5 years, health care workers and caregivers. Data were collected using a structured observation checklist of the case management of sick children, exit interviews with caregivers, and a structured inventory checklist for equipment, drugs and supplies at each health facility. Results. Nine facilities, 17 nurses and 72 children were observed during the study. Seventeen children (24%) were assessed for the three general danger signs (failure to drink or breastfeed, vomiting everything ingested, and convulsions), 31 (43%) were correctly prescribed an oral antibiotic, and 11% received the first dose of treatment at the health facility. Thirty-two per cent of caregivers who received a prescription for an oral medication were able to report correctly how to give the treatment. Drugs were below minimum stock levels in all 9 facilities. Only 19 (20%) of the 94 nurses were trained in IMCI. Conclusion. IMCI implementation in Bulawayo failed to meet the accepted standard protocol requirements. The main deficiencies noted were the low number of IMCI-trained health workers and the lack of availability of essential drugs at health facilities. However, it was noteworthy that only two case assessment parameters differed statistically between IMCI-trained and non-trained nurses. Larger studies are needed to confirm or refute these findings.