The effect of Integrated Management of Childhood Illness on observed quality of care of under-fives in rural Tanzania
The effect of Integrated Management of Childhood Illness on observed quality of care of under-fives in rural Tanzania
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DOI：
10.1093/heapol/czh001
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发表时间：
2004-01-01
影响因子：
3.2
通讯作者：
Wilczynska, K
中科院分区：
文献类型：
--
作者：
Schellenberg, JA;Bryce, J;Wilczynska, K
儿童疾病综合管理已被80多个国家采纳，作为降低儿童死亡率和改善儿童健康与发展的战略。它包括旨在解决社区、卫生设施和卫生系统各级儿童死亡主要原因的补充干预措施。儿童疾病综合管理成效、成本和影响多国评价是一项全球评价，旨在确定儿童疾病综合管理对健康结果的影响及其成本效益。履行和评价由世界卫生组织儿童和青少年健康与发展部协调。孟加拉国、巴西、秘鲁、坦桑尼亚和乌干达正在进行履行和监测教育研究。在坦桑尼亚，儿童疾病综合管理-监测和监测研究采用了一种非随机观察设计，比较了四个邻近地区，其中两个地区自1997年以来一直在实施儿童疾病综合管理，并在地区一级进行循证规划和支出绘图，另外两个地区于2002年开始实施儿童疾病综合管理。在这四个地区，儿童健康和儿童生存情况分别通过横向、前后调查和纵向人口监测在家庭一级得到记录。在这里，我们提出的调查结果在2000年8月进行的分层随机抽样的政府卫生设施比较的质量的病例管理和卫生系统的支持在儿童疾病综合管理和比较区。结果表明，儿童疾病综合管理区的儿童比对照区的儿童得到了更好的照顾：他们的健康问题得到了更彻底的评估，他们更有可能得到诊断和正确的治疗，这是通过黄金标准重新检查确定的，儿童的照顾者更有可能得到适当的咨询，并报告说，他们对如何照顾生病的孩子的知识水平更高。儿童疾病综合管理和比较区在卫生系统对设施一级儿童保健服务的支持水平方面差别不大。这项研究表明，儿童疾病综合管理，在一个分散的卫生系统与实用的卫生系统规划工具的存在，是可行的，在资源贫乏的国家实施，并能导致迅速提高病例管理的质量。因此，如果能够达到并保持适当的覆盖率，儿童疾病综合管理有可能导致儿童生存、健康和发展方面的迅速进展。
Integrated Management of Childhood Illness (IMCI) has been adopted by over 80 countries as a strategy for reducing child mortality and improving child health and development. It includes complementary interventions designed to address the major causes of child mortality at community, health facility, and health system levels. The Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (IMCI-MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. The MCE is coordinated by the Department of Child and Adolescent Health and Development of the World Health Organization. MCE studies are under way in Bangladesh, Brazil, Peru, Tanzania and Uganda. In Tanzania, the IMCI-MCE study uses a non-randomized observational design comparing four neighbouring districts, two of which have been implementing IMCI in conjunction with evidence-based planning and expenditure mapping at district level since 1997, and two of which began IMCI implementation in 2002. In these four districts, child health and child survival are documented at household level through cross-sectional, before-and-after surveys and through longitudinal demographic surveillance respectively. Here we present results of a survey conducted in August 2000 in stratified random samples of government health facilities to compare the quality of case-management and health systems support in IMCI and comparison districts. The results indicate that children in IMCI districts received better care than children in comparison districts: their health problems were more thoroughly assessed, they were more likely to be diagnosed and treated correctly as determined through a gold-standard re-examination, and the caretakers of the children were more likely to receive appropriate counselling and reported higher levels of knowledge about how to care for their sick children. There were few differences between IMCI and comparison districts in the level of health system support for child health services at facility level. This study suggests that IMCI, in the presence of a decentralized health system with practical health system planning tools, is feasible for implementation in resource-poor countries and can lead to rapid gains in the quality of case-management. IMCI is therefore likely to lead to rapid gains in child survival, health and development if adequate coverage levels can be achieved and maintained.