An assessment of compliance to integrated management of childhood illness guidelines and management systems in Langata, Nairobi county

Abstract

Background World Health Organization estimates about 10 million children die annually mostly in developing countries. In Kenya, Demographic Survey of 2008 reported infant and child mortality of 74 and 52 deaths per 1,000 respectively. Targets of 25 and 33 deaths per 1000, has not been achieved despite implementing Integrated Management of Child hood Illnesses (IMCI) strategy since 1997. Management systems like trainings, availability of drugs and management meetings need to be well understood so that they can support implementation of IMCI Objectives: To assessthe compliance of health care workers with IMCI guidelines and management systems in three Amref supported facilities by; Assessingthe compliance of health care workers with IMCI guidelines, describing the IMCI management systems available according to IMCI strategy and explaining factors that promote or hinder IMCI implementation Methodology: Cross sectional descriptive facility based survey. Both quantitative and qualitative data was collected using questionnaires and key informant interview guide. The study was conducted at three health centers in Nairobi County. Care giver sample size was arrived at through proportionate sampling in the facilities and selection done using systemic interval sampling. Exit interviews on 351 caregivers and 3 key informant interviews were conducted about compliance of health care workers to IMCI and management systems. Inclusion criteria entailed caregivers of children aged between 2 and 59 months who had been brought to the Outpatient departments. Data was entered and analysed using SPSS software Results: Overall, 351 caregivers interviewed. Three key informant interviews conducted with facility in charges a nurse and two clinicians. Majority of the caregivers were 97.7% femalewith 78 % being married. About 75.2% were below 30 yearsand 96% were mothers of the children. All (100 %) of the health centers held no IMCI specific meetings. Management meetings were irregular with no documented proceedings. Support supervision was irregular with no facility having the support supervision visit schedule. All facilities had basic medicines and equipment recommended by IMCI. Health care worker compliance to IMCI guidelines on pre assessment and danger signs stood at less than 51 % and less than 41% respectively and 22% on major symptoms. Partner collaboration and facility set up change promoted IMCI implementation while lack of commitment, high work load and lack of forms hindered IMCI implementation. Conclusions:Despite the trainings done, health care workers’ compliance to the IMCI guidelines was poor and this was attributed to weak management systems.Management systems in relation to IMCI implementation especially management meetings were weak. Supportsupervisionwas not institutionalized. Donor and partners support and also change of facility set up had promoted IMCI implementation while lack of commitment and high work load hindered IMCI implementation in the three facilities. Recommendations: The study recommends that, at policy level,institutionalization of effective supportive supervision for health care workers. At program implementation level, Amref to come up with a strategy to motivate health care workers to comply with IMCI guidelines and further research recommended on barriers to effective supportive supervision among the District Management teams (DHMTs) and also one to find out if compliance to IMCI protocols has better outcomes in management of childhood diseases in these facilities