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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 |
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