EFFECTIVENESS OF dIMCI TRAINING IN DISTRICT ABBOTTABAD, KHYBER PAKHTUNKHWA: AN EXTERNAL PILOT STUDY

Authors

  • Saidul Abrar PhD scholar HSA Islamabad
  • Assad Hafeez Vice Chancellor, Health Services Academy
  • Muhammad Naseem Khan Professor of Public Health, HSA
  • Muhammad Zeeshan Haroon Department of Community Medicine, Ayub Medial College Abbottabad
  • Ayesha Khan Humanitarian Relief Foundation-Pakistan

Keywords:

Pilot, Feasibility, Eligibility, IMCI , dIMCI

Abstract

Background: Five million deaths per year in under-five children are reported to be due to preventable and treatable causes. IMCI strategy targets these causes through improvement in the case management skills of health care workers. The objectives of this study were to identify eligible clusters and identify & rectify any process, resources, and management-related issues for the main trial. Methods: This study was conducted in two phases. Phase 1 was conducted for eligibility of Basic Health Units from which sample can be drawn for the main cluster randomized control trial. A single-page proforma was sent to all 54 BHUs of Abbottabad through registered mail service and replies received were analysed through SPSS-V25 and MS Excel-2016. Afterward a sample of 26 BHUs was drawn for the definitive trial. In phase 2, four BHUs were conveniently selected from the remaining sampling frame; one in the control arm while three in the intervention arm. From each BHU, a health care worker responsible for under-five consultations was trained; control arm in standard IMCI while intervention arm on distance learning IMCI. Ten observations in the form of cases managed were assessed at each BHU by a gold standard IMCI master trainer after a specific period. Descriptive summary measures and 95% CI were calculated using SPSS-V25. Results: Out of 54 BHUs, 3 were nonrespondents while 36 were identified as an eligible sampling frame. The mean index of integrated assessment was found to be 0.90 and 0.89 for the control and intervention arm respectively. Discrepancies in filled forms were noted as 60% in control while 63.3% in intervention arm. Conclusion: Modifications in the plan for the main trial based on the findings of pilot study can ensure credibility and rigor in the definitive trial.

References

WHO. Children: improving survival and well-being 2020 [cited 2020 December 11, 2020]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/children-reducing-mortality.

Kumar D, Sabella C. Measles: Back again. Cleve Clin J of Med 2016;83(5):340–4.

Kobaidze K, Wallace G. Forgotten but not gone: Update on measles infection for hospitalists. J Hosp Med 2017;12(6):472–6.

Bester JC. Measles and Measles Vaccination. JAMA Paediatr 2016;170(12):1209–15.

WHO. Towards a Grand Convergence for Child Survival and Health 2016 [cited 2020 December 12]. Available from: https://www.who.int/publications/i/item/towards-a-grand-convergence-for-child-survival-and-health.

Gove S. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bulletin of the World Health Organization. 1997;75 (Suppl 1):7–24.

Gera T, Shah D, Garner P, Richardson M, Sachdev HS. Integrated management of childhood illness (IMCI) strategy for children under five. Cochrane Database of Systematic Reviews. 2016(6).

Amin H, Yasin H, Danish SH, Ahmad F, Rasheed S, Zehra N, et al. Appraisal of knowledge, attitude and practices of trained doctors regarding IMNCI. Pak J Med Dent 2015;4(01):47.

Boschi-Pinto C, Labadie G, Dilip TR, Oliphant N, Dalglish SL, Aboubaker S, et al. Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on. BMJ open. 2018;8(7):e019079.

Bryce J, Victora CG, Habicht JP, Black RE, Scherpbier RW. Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness. Health policy and planning. 2005;20 Suppl 1:i5-i17.

WHO. Child health and development 2014 [cited 2019 April 13]. Available from: http://www.emro.who.int/child-health/imci-strategy/three-components.

WHO. IMCI Distance Learning Course:Introduction-Self-Study Modules 2014 [cited 2017 February 22]. Available from: https://apps.who.int/iris/bitstream/handle/10665/104772/9789241506823_Intro_self-study_eng.pdf?sequence=1.

Mazumder S, Taneja S, Bahl R, Mohan P, Strand TA, Sommerfelt H, et al. Effect of implementation of integrated management of neonatal and childhood illness programme on treatment seeking practices for morbidities in infants: cluster randomised trial. BMJ (Clinical research ed). 2014;349:g4988.

WHO. IMCI Distance Learning Course:Implementation – Introduction and Roll Out 2014 [cited 2017 February 23]. Available from: https://apps.who.int/iris/bitstream/handle/10665/104772/9789241506823_Introduction_roll-out_eng.pdf?sequence=14.

WHO. Implementation of IMCI in Pakistan: Introduction Phase 2014 [cited 2016 April 2]. Available from: http://www.emro.who.int/child-health/strategy-implementation/implementation-of-imci-in-pakistan.html.

NIPS. Download PDHS and PMMS Data Set 2019 [cited 2019 30 March ]. Available from: https://www.nips.org.pk/study_detail.php?detail=MTgw.

WHO. World Health Statistics data visualizations dashboard 2020 [cited 2020 December 14]. Available from: https://apps.who.int/gho/data/view.sdg.3-2-data-ctry?lang=en.

UN. Sustainable development Goals 2016 [cited 2018 June 6]. Available from: https://sustainabledevelopment.un.org/topics/sustainabledevelopmentgoals.

Weaver E, Markiewicz M, Kwesigabo G, J L. Assessing Training Approaches and a Supportive Intervention for Managing Febrile Illness in Tanzania – Tibu Homa Performance Evaluation Report 2017 [cited 2019 March 2]. Available from: https://measureevaluation.cpc.unc.edu/resources/publications/tre-17-1.html.

HSRU. Sample size calculator for cluster randomised trial 2018 [cited 2018 Sept 26]. Available from: https://www.abdn.ac.uk/hsru/what-we-do/tools/index.php#panel177.

Eldridge S, Kerry S. A practical guide to cluster randomised trials in health services research. West Sussex,UK: John Wiley & Sons; 2012.

Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, et al. A tutorial on pilot studies: the what, why and how. BMC medical research methodology. 2010;10:1.

Published

2021-11-08