ABSTRACT
Background: India has around 240 million under-five children and contributes close to 25% of under-five mortality. About 70% of such deaths are due to diarrhea, pneumonia, measles, malaria or malnutrition and often a combination of these conditions. These are also the diseases that are seen to afflict three out of every four sick children seeking care at a health facility. Aim of the study: To evaluate the utility of the WHO / UNICEF guidelines for “Integrated Management of Neonatal and Childhood Illness” among children aged two months to five years attending an Urban center. Materials and methods: This Prospective observational study was did in the outpatient department and emergency room, The Institute of child Health and Hospital for Children, Egmore, Chennai. Children attending the outpatient department and emergency room aged between 2 months and 5 years for the first time for a fresh complaint due to any illness were included in the study. Each study subject was assessed and classified according to IMNCI guidelines and the treatment options were identified and recorded in a proforma. Each child was evaluated using IMNCI algorithms for high Venkatesh Periasami, Senthilkumar Palanivelu. Evaluation of the utility of IMNCI algorithm in predicting illness, hospitalization, and management of children aged 2 months to 5 years in a tertiary referral centre. IAIM, 2019; 6(3): 73-82. Page 74 malaria risk areas and low malaria risk areas. The IMNCI algorithm was split into four modules dealing with specific complaints (cough/breathing difficulty, diarrhea, fever, ear problems) and the classification and treatment options arrived at for each child on applying the specific split algorithms guided by the presenting complaints were also noted. Results: 517 complaints were reported by the parents/other caregivers accompanying the children enrolled in the study; an average of 1.72 complaints per child. depicts the frequency of these symptoms. Over 43% (227) of such complaints comprised of respiratory problems such as cough or difficulty in breathing. One-fourth of all presenting complaints (125) were fever and another 10% (56) consisted of loose or bloody/mucoid stools. Other complaints frequently reported were convulsions (15, 2.9%), vomiting everything (14, 2.7%), lethargy/unconsciousness (11, 2.1%), not being able to drink/breastfeed (11, 2.1%) and ear problems (9, 1.7%). Conclusion: Multiple diagnoses are the rule than an exception in under five sick children. Hence vertical, disease-specific algorithms are inappropriate in the evaluation and management of a sick child. Integrated approaches must be preferred. The IMNCI algorithm can address most complaints that sick children present with. When implemented by health workers with appropriate training, the referral criteria of IMNCI are fairly good predictors of serious illness which requires medical attention.