Integrated Management of Childhood Illness (IMCI) in Bangladesh: early findings from a cluster-randomised study
Integrated Management of Childhood Illness (IMCI) in Bangladesh: early findings from a cluster-randomised study
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DOI：
10.1016/s0140-6736(04)17312-1
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发表时间：
2004-10-30
期刊：
影响因子：
168.9
通讯作者：
Bryce, J
中科院分区：
文献类型：
--
作者：
El Arifeen, S;Blum, LS;Bryce, J
背景我们报告的初步调查结果，从一个持续的集群随机评估的综合管理儿童疾病（IMCI）的战略在Bangladesh.Methods 20个一级门诊设施在Madab分区和他们的集水区被随机分配到IMCI或标准护理。在基线时对家庭和卫生设施进行了调查，并在实施后约2年重复进行调查。记录了使用保健设施的数据。IMCI的实施包括卫生工作者培训，卫生系统的支持，和社区一级的活动，引导形成research.Findings 94%的卫生工作者在干预设施的IMCI培训。保健系统的支助一般都可以得到，但社群活动的执行缓慢。在儿童疾病综合管理设施中，患病儿童正确治疗的平均指数为54，而对照设施为9（范围为0 - 100）。儿童疾病综合管理设施的使用率从基线时的每年每名儿童0.6次增加到引入儿童疾病综合管理后约21个月的每年每名儿童1.9次。19%的患病儿童在儿童疾病综合管理领域采取了一个卫生工作者相比，9%的非儿童疾病综合管理area.Interpretation 2年的评估，结果显示，在卫生设施的护理质量的改善，增加使用的设施，和收益的比例患病儿童采取适当的卫生保健提供者。这些研究结果正被用于加强全国范围内的儿童保健。他们建议，可以通过投资于保健质量和保健系统支助来改善保健设施利用率低的情况。
Background We report the preliminary findings from a continuing cluster randomised evaluation of the integrated Management of Childhood Illness (IMCI) strategy in Bangladesh.Methods 20 first-level outpatient facilities in the Madab sub-district and their catchment areas were randomised to either IMCI or standard care. Surveys were done in households and in health facilities at baseline and were repeated about 2 years after implementation. Data on use of health facilities were recorded. IMCI implementation included health worker training, health systems support, and community level activities guided by formative research.Findings 94% of health workers in the intervention facilities were trained in IMCI. Health systems supports were generally available, but implementation of the community activities was slow. The mean index of correct treatment for sick children was 54 in IMCI facilities compared with 9 in comparison facilities (range 0-100). Use of the IMCI facilities increased from 0.6 visits per child per year at baseline to 1.9 visits per child per year about 21 months after IMCI introduction. 19% of sick children in the IMCI area were taken to a health worker compared with 9% in the non-IMCI area.Interpretation 2 years into the assessment, the results show improvements in the quality of care in health facilities, increases in use of facilities, and gains in the proportion of sick children taken to an appropriate health care provider. These findings are being used to strengthen child health care nationwide. They suggest that low levels of use of health facilities could be improved by investing in quality of care and health systems support.