Promoción de la salud a través de prácticas claves en la atención integrada a las enfermedades prevalentes de la infancia (AIEPI), en profesores de educación prebásica / Health promotion through key practices in integrated attention to prevalent childhood illnesses (IMCI), in pre-basic education teachers

Introducción: la estrategia de atención integrada a las enfermedades prevalentes de la infancia (AIEPI), avanza en el concepto de integralidad de la atención de la salud, siendo una herramienta práctica, en los servicios de salud y hogar, establece máxima validez a las preocupaciones de la comunidad y del personal de salud. Objetivo: conocer la promoción de la salud a través de prácticas claves en la atención integrada a las enfermedades prevalentes de la infancia (AIEPI), en profesores de educación prebásica. Material y métodos: investigación descriptiva en población de 59 técnicos y profesionales adscritos a jardines infantiles y salas cuna, en la ciudad de Temuco, que corresponden a 23 salas cuna, que ejercen actividades laborales con lactantes de 6-12 meses. Recolección de información, y instrumento de prácticas claves propuestas por AIEPI OMS/OPS, el análisis se trabajó con estadística descriptiva e inferencia estadística, apoyándose en el software SPSS versión 24 en español. La investigación cumplió los criterios de rigor ético de Ezequiel Emanuel y la aprobación del Comité de Ética acreditado de la Universidad Mayor. Resultados: 59 personas, de sexo femenino, personal de atención en la guardería de jardines infantiles y salas cuna. La edad promedio de 40 años, promedio de 8 años de ejercicio técnico profesional. El 78% del personal de atención en la guardería, posee una jornada laboral de 9 horas diarias. Respecto a las conductas en lactancia materna un 78 %, "siempre" realiza fomento del amamantamiento y un 72,9 % "siempre" fomenta los beneficios de la lactancia materna; no obstante, en cuanto al fomento de la técnica de acople, "a veces" fomenta la técnica un 39,8 %. De la inmunización un 64,4 % del personal parvulario, "siempre fomenta la vacunación del PNI", por otro lado, un 71 % de la muestra "siempre fomenta la administración de vacunas de campaña (influenza)". De la conducta por cuadro respiratorio, un 69,5 % de la población, "siempre reconoce los signos y síntomas que alertan de un cuadro respiratorio". Conclusión: en la comunidad educativa, el uso de la estrategia desarrolla un actuar más efectivo, identificando actitudes de promoción. El tener la posibilidad de contacto diario; permite a la comunidad de prebásica dirigir su mirada hacia los problemas más relevantes y proponer estrategias para la solución en conexión con el sector salud

Introduction: the strategy of Integrated Attention to Prevalent Childhood Diseases (IMCI), advances in the concept of comprehensive health care, being a practical tool, in health and home services, giving maximum validity to concerns of the community and health personnel. Objective: to know the promotion of health through key practices in Integrated Attention to Prevalent Childhood Illnesses (IMCI), in pre-basic education teachers. Material and Methods: Descriptive research in a population of 59 technicians and professionals assigned to Kindergartens and Nursery Rooms, in the city of Temuco, corresponding to 23 Nursery Rooms, who carry out work activities with infants aged 6-12 months. Information collection and key practices instrument proposed by IMCI WHO / PAHO. The analysis was carried out with descriptive statistics and statistical inference, relying on the SPSS software version 24 in Spanish. The research met the criteria of ethical rigor of Ezequiel Emanuel and the approval of the accredited Ethics Committee of the Universidad Mayor. Results: 59 people, female, nursery care personnel from Kindergartens and Nursery Rooms. The average age of 40 years, average of 8 years of professional technical practice. 78% of the kindergarten staff have a 9-hour workday. Regarding breastfeeding behaviors, 78% "always" promote breastfeeding and 72.9% "always" promote the benefits of breastfeeding, however, regarding the promotion of the coupling technique, "a times", 39.8% promote the technique. Of the immunization, 64.4% of the kindergarten staff "always promote the PNI vaccination", on the other hand, 71% of the sample "always promote the administration of field vaccines (Influenza)". Of the behavior due to respiratory symptoms, 69.5% of the population "always recognize the signs and symptoms that warn of a respiratory condition". Conclusion: in the educational community, the use of the strategy develops a more effective action, identifying attitudes of promotion. Having the possibility of daily contact; allows the pre-basic community to direct its gaze towards the most relevant problems and propose strategies for the solution in connection with the health sector.

Evaluation of the WHO/UNICEF algorithm for integrated management of childhood illness

Background: The present study was designed to evaluate the feasibility and utility of the integrated management of the childhood illness (IMCI) algorithm to diagnose the illnesses in children under the age of 2 months to 5 years.Methods: The study was conducted on 300 children, aged 2 months to 5 years, who presented with a fresh episode of any illness to the out-patient Department of the SMGS Hospital over a period of 9 months. Within these initial selection criteria, the WHO/UNICEF algorithm for management of the sick child was referred to, children were assessed and classified as per "IMCI" algorithm and treatments required were identified. The final diagnosis was made and appropriate therapy instituted served as the "Gold standard". The diagnostic and therapeutic agreements between the 'gold standard' and the IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed.Results: Among all 300 subjects, more than one illness was present in 207 (69%) of subjects as per Gold standard diagnosis. The corresponding, figures for IMCI module were 141 (47%) and 222 (74%) for low and high malaria algorithms respectively. The mean illnesses per child were 2.12, 182 and 2.21, respectively. The subjects who would have been referred as per IMCI module had a greater co-existence of illnesses than those who would not have been referred (mean 2.5 versus 1.5 illnesses per child respectively). The specificity for general danger signs was 66% while the sensitivity was 71%.Conclusions: In conclusion, the performance of the IMCI algorithm is significantly better than the vertical disease specific algorithm. In addition, the IMCI algorithm incorporates an element of preventive care in the form of immunization and feeding advice.

Prácticas pa ra la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia) / Practices for the prevention of accidents in the home in caregivers of children from 1 to 5 years in a district of Cartagena (Colombia)

Introducción: los accidentes en la población infantil constituyen una importante causa de morbilidad y mortalidad convirtiéndose hoy día en un problema de salud pública mundial, principalmente la población más afectada son los niños en etapa preescolar, por la vulnerabilidad y dependencia del cuidador. Objetivos: describir las prácticas para la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia). Materiales y métodos: estudio cuantitativo descriptivo transversal. Constituido por 354 cuidadores de niños menores de 5 años, se utilizó la técnica de observación y la aplicación del instrumento con base a la práctica N° 15 de AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia). Resultados: socio demográficamente los cuidadores fueron principalmente de género femenino (87%), con 20 ­ 29 años de edad (44,9%), madres de los niños (61,3%), conviven en unión libre (54,2%), son bachilleres (50,3%), de estrato uno (91,8%), amas de casa (62,7%), con hijos (93,8%), residen en casas (54,5%). Los niños de 1 a 5 años fueron mayoritariamente de género masculino (51,7%), y han presentado accidentes (75,1%), sobre todo, caídas (61,9%). El nivel de riesgo de accidentes en el hogar fue bajo (85%), y las prácticas de prevención suelen ser regulares (55,1%). Conclusión: los niños enfrentan relativamente bajo riesgo de accidente en el hogar, sin embargo, las prácticas para prevenirlos resultan ser regulares..(AU)

Introduction: accidents in children are an important cause of morbidity and mortality,becoming today a global public health problem, mainly the most affected population are children in preschool, for the vulnerability and dependence of the caregiver. Objectives:to describe the practices for the prevention of accidents at home in caregivers of children from 1 to 5 years of age, in a neighborhood of Cartagena (Colombia). Materials and methods: quantitative, descriptive and cross-sectional study. Consisting of 354 caregivers of children under 5 years of age, the technique of observation and the application of the instrument was used based on practice No. 15 of IMCI (Integrated Management of Childhood Illness). Results: demographic partner caregivers were mainly female (87%), with 20 - 29 years of age (44.9%), mothers of children (61.3%), live together in a free union (54.2%), are high school graduates (50.3%), of stratum one (91.8%), housewives (62.7%), with children (93.8%), reside in houses (54.5%). Children from 1 to 5 years old were male (51.7%), and had accidents (75.1%), especially falls (61.9%). The level of accident risk in the home was low (85%), and prevention practices are usually regular (55.1%). Conclusion: children face relatively low risk of accident in the home, however, practices to prevent them turn out to be regular..(AU)

Aplicación de la estrategia de Atención Integral de Enfermedades Prevalentes de la Infancia en Ecuador / Implementation of the strategy of Integrated Management of Childhood Illnesses

Introducción: la estrategia de Atención Integral de Enfermedades Prevalentes de la Infancia desarrollada por la Organización Mundial de la Salud y la UNICEF, puede reducir la mortalidad infantil y estimular el uso racional de antibióticos. Objetivo: valorar el cumplimiento de la mencionada estrategia en términos de diagnóstico y tratamiento, en especial el tratamiento con antibióticos, en niños con infección respiratoria aguda en el Ecuador. Métodos: se revisaron las historias clínicas de pacientes que tenían entre dos meses y cinco años de edad, que habían sido atendidos en dos centros de atención primaria de salud en zonas urbanas y rurales, donde los niños reciben atención médica gratuita, entre julio de 2010 y Junio de 2011. Se recolectaron retrospectivamente los datos sobre las características del paciente, diagnóstico y tratamiento. Resultados: en ambos centros de salud y en la mayoría de las historias clínicas se constató la falta de información sobre el tratamiento y la administración de los antibióticos. Se recopilaron los datos de 1 063 pacientes, que revelaron que la prescripción excesiva de antibióticos se produjo con mayor frecuencia (6,50 %) en los centros de atención rural. Conclusiones: hay incumplimiento parcial en la aplicación de la estrategia y es importante en investigaciones futuras profundizar en sus causas. La inaccesibilidad a los servicios de salud podría ser una causa asociada, especialmente en las zonas rurales. La contextualización de la estrategia puede ser necesaria para mejorar la salud infantil, promover el uso racional de los antibióticos y reducir la diseminación de resistencias antimicrobianas.

Introduction: the strategy of Integrated Management of Childhood Illnesses (IMCI) developed by the World health Organization and the UNICEF is aimed at reducing infant mortality and at promoting the rational use of antibiotics. Objective: to evaluate the performance of the above-mentioned strategy for children with acute respiratory infections in Ecuador, in terms of diagnosis and treatment, particularly antibiotic therapy. Methods: the medical histories of patients aged two months to five-years old, who had been diagnosed with ARI and treated at 2 primary health care centers in urban or rural areas in the period of July 2010 through June 2011, were checked. Data about the characteristics of the patients, the diagnosis and the treatment followed were retrospectively collected. Results: in both primary health centers and in most of the medical records, information about the lines of treatment and administration of antibiotics was missing. Data collected on 1 063 patients revealed that over-prescription of antibiotics occurred more frequently in health centers located in rural areas (6.5 %). Conclusion: future research should focus on identifying the causes of failure in the IMCI implementation. The inaccessibility to health centers may be an example of associated causes, especially in rural areas. The contextualization of the IMCI strategy may be needed to improve child health, to promote the rational use of antibiotics and to reduce the spread of antimicrobial resistance.

Review of Paediatrics Inpatient at a Zonal Hospital.

Introduction: Childhood illnesses cause significant number of admissions in different level hospitals. This retrospective study was undertaken to analyze the morbidity pattern in the Paediatric ward at a Zonal Hospital with aim that the results obtained will help in planning, prioritizing and implementing preventive, promotive and curative health care activities of the children in resource poor community. Materials and Methods: This study was carried out retrospectively for one year from July/Aug 2010 – June/July 2011. Age, sex, diagnosis, month of admission, duration of admission and the frequency of diseases were evaluated. Results: A total number of 977 patients were admitted during the study period. There were 579(59%) male and 398(41%) female children. Less than five years age group accounted for 569(58%) excluding the neonates. In the study period, respiratory tract infections were the commonest cause of admission 309(31.6%), gastrointestinal including diarrhoeal diseases were 278(28.5%), enteric fever comprised of 69(7%), and other diseases comprised of about 390(39.5%). Of the total admissions, CNS diseases comprised of 128(13%) of which 29(3%) were meningitis and meningoencephalitis. Sixty seven (52%) of the total CNS cases were due to febrile convulsion. Renal and cardiovascular diseases were 8.5% and 1.5% respectively. Conclusion: Children under five years of age being the most common age group amongst all, with respiratory and gastrointestinal diseases still being the most predominant cause of paediatric morbidity; community level interventions including IMCI should be strengthened for reducing hospital admissions, along with allocation of hospital beds and supplies as per morbidity pattern.

Introducción del Manual de Enfermedades Prevalentes de la infancia en la enseñanza de Enfermería en Cuba / Introduction to the Manual of Childhood Illnesses in the education of nursing in Cuba

Introducción: La estrategia de Atención Integrada a las Enfermedades Prevalentes en la Infancia (AIEPI) implementada desde 1996 en la Región de las Américas y el Caribe se materializa en un Manual Clínico, en ella el manejo integrado de todas las actividades busca mejorar las competencias del personal de salud, mejorar las prácticas de cuidado del niño en la familia y la comunidad, así como fortalecer los sistemas de salud. Cuba a través de la Red Nacional de Salud Infantil (Red ENSI) recibe la solicitud de unirse a la investigación para implementar el Manual AIEPI en la enseñanza de enfermería considerando los logros obtenidos por el país a través del Programa de Atención Materno Infantil. Objetivos: diseñar una metodología para la introducción del Manual AIEPI en la carrera de Licenciatura en Enfermería, Métodos: se utilizaron métodos empíricos y teóricos, revisión documental y criterio de expertos. El universo de estudio estuvo constituido por los integrantes del grupo coordinador nacional, coordinadores provinciales y otros profesionales de la salud miembros de la Red ENSI-CUBA, así como profesores de enfermería pediátrica de las Universidades de Ciencias Médicas. Resultados y conclusiones: Se concluyó con el ordenamiento de los pasos a través de etapas para la enseñanza de AIEPI en enfermería(AU)

Introduction: The strategy of the Integrated Management of Childhood Illnesses (IMCI) implemented since 1996 in the Region of the Americas and the Caribbean is embodied in a Clinical Manual, where integrated management of all activities look for improving skills of health personnel, to improve child care practices in the family and community, as well as to strength the health systems. Cuba through the National Network of Child Health (ENSI Network) receives the request to join the research to implement the IMCI Manual in nursing education, considering the achievements of the country through the Maternal and Child Care Program. Objectives: To design a methodology for the introduction of IMCI Manual in the university studies of Nursing, Methods: There were used empirical and theoretical methods, documentary review and criteria of experts. The universe was composed of members of the national coordinating group, provincial coordinators and other health professional members of the ENSI-CUBA Network, as well as professors of pediatric nursing of the Universities of Medical Sciences. Results and Conclusions: It was concluded with the ordering of the steps through stages for the teaching of IMCI in nursing(AU)

Práticas dos enfermeiros na estratégia de atenção integrada às doenças prevalentes na infância / Practice of nurses in integrated care strategy for childhood illness

A estratégia da Atenção Integrada às Doenças Prevalentes na Infância, desenvolvida pela Organização Mundial da Saúde e Fundo das Nações Unidas para a Infância, pretende reduzir a mortalidade infantil por meio de ações que visam melhorar o desempenho dos profissionais de saúde, a organização do sistema de saúde e as práticas da família e da comunidade. Partindo desse pressuposto, o presente estudo teve como objetivo identificar as dificuldades e facilidades das práticas dos enfermeiros que atuam na Estratégia de Saúde da Família, relacionadas à aplicabilidade da AIDPI. Utilizou-se o método exploratório descritivo, com abordagem qualitativa, realizada com oito enfermeiros da zona urbana da Estratégia Saúde da Família de Campina Grande, no período de agosto a outubro de 2011. Os dados foram coletados por meio de um roteiro de entrevista semiestruturado. Para análise dos dados,utilizou-se o método de analise de conteúdo do tipo categorial temática, proposto por Bardin.Este estudo atendeu à Resolução 196/96 do Conselho Nacional de Saúde, e foi aprovado pelo comitê de ética e pesquisa do Centro de Ensino Superior e Desenvolvimento aprovado sob o protocolo de n° 00810.405.000.11.Os resultados foram dispostos em duas categorias analíticas: Aplicabilidade da Estratégia AIDPI pelos enfermeiros e Dificuldades para execução da AIDPI.Os resultados assinalam a importância da AIDPI por ser um instrumento sistematizado, que facilita a abordagem e gera mais segurança na condução da consulta do enfermeiro. Quanto às dificuldades, os sujeitos enfatizam a não disponibilização de um roteiro específico para ser utilizado na consulta e a falta de apoio para prescreverem medicamentos, gerando insegurança no atendimento. Os resultados nos levam a concluir que é necessário um trabalho de educação permanente para a aplicação das ações propostas pela AIDPI, de forma a promover uma atenção integral na assistência à saúde da criança, baseada em conhecimentos científicos.

The strategy of Integrated Management of Childhood Illness, developed by the World Health Organization and United Nations Children's Fund, aims at reducing infant mortality through actions to improve the performance of health professionals, the organization of the health system and the family and community practices. This study aimed to evaluate the practices of nurses working on the Family Health Strategy related to the applicability of IMCI. It was used the exploratory descriptive method with a qualitative approach, carried out with nurses in the urban area of the Family Health Program in Campina Grande, from August to October 2011. The sample consisted of eight subjects. The data were collected through a structured interview. For the data analysis, the content analysis method of categorical theme proposed by Bardin was used. This study complied with Resolution 196/96 of the National Health Council in which the project was submitted to the ethics committee and research of the Center for Superior Teaching Development. It was carried out only after approval under protocol n. 00810.405.000.11. The qualitative results were arranged in two analytical categories: Applicability of IMCI by the nurses and difficulties to implement the IMCI. The results highlight the importance of IMCI as an instrument that facilitates the systematic approach and generates more driving safety consulting the nurse. As for the difficulties, the subjects emphasize the availability of a specific script to be used in consultation and lack of support for prescription drugs, generating uncertainty in attendance. The results lead us to conclude that a continuous education work is necessary to further the actions proposed by IMCI in such a way that it promotes a more comprehensive focus on health care to the child, based on scientific knowledge.

Conocimientos y prácticas del cuidador como factor asociado a enfermedad respiratoria aguda en niños de 2 meses a 5 años / Conhecimentos e práticas do responsável como fator associado à doença respiratória aguda em crianças de 2 meses a 5 anos / Knowledge and practices of the caregiver as a factor associated to acute respiratory infection in children from 2 months to 5 years old

Objetivo. Establecer la relación existente entre la Enfermedad Respiratoria Aguda (ERA) y los conocimientos y prácticas que tiene el cuidador del niño. Metodología. Estudio de casos y controles en el que los casos fueron los niños hospitalizados por ERA y los controles los niños hospitalizados por causas diferentes. Se realizó entrevista a los cuidadores de los niños con el fin de indagar el nivel de conocimientos y prácticas que tenían con respecto a la ERA. Resultados. Se estudiaron 24 casos y 24 controles. El perfil del cuidador de ambos grupos de estudio es el de mujeres, madres del menor, amas de casa, con nivel educativo de secundaria, afiliadas al régimen contributivo y de estratos socioeconómicos 2 y mayores. Los cuidadores de los casos tuvieron menor proporción de conocimientos adecuados sobre ERA que los de los controles (41.7% versus 75.0%, p=0.02). Un bajo de cuidadores en ambos grupos identifica adecuadamente los signos y síntomas de ERA (casos=4.2% y controles=8.2%). El conocimiento de cuándo consultar de manera urgente fue adecuado en el 75.0% de los cuidadores de los casos versus 66.7% de los cuidadores de los controles. En las prácticas desarrolladas cuando el niño tiene ERA los cuidadores de los controles, la que más realizan es el adecuado manejo de la fiebre, el resto de prácticas tuvieron proporciones de manejo adecuado entre regulares y malas. Conclusión. Los conocimientos y prácticas en los cuidadores fueron inadecuados, se evidencia la necesidad de implementar y reforzar acciones educativas en la comunidad.

Objective. To establish the relationship between Acute Respiratory Infection (ARI) and the practices and knowledge the child caregiver has. Methodology. Case-control study in which cases were children hospitalized for ARI, and controls children hospitalized for other conditions. Interviews were applied to the children’s caregivers to investigate their level of knowledge and practices related to ARI. Results. 24 cases and 24 controls were studied. The caregiver profile in both groups were women, mother of the child, housekeeper, high school level of education, members of the contributive regimen, and from socioeconomic status 2 and higher. The cases group caregivers had a lower proportion of proper IRA knowledge than controls (Cases=4.2% and controls=8.2%). Knowledge about when to consult as an emergency was proper in the 75.0% of the caregivers in the case group versus 66.7% in the control group. In the actions taken when the child has IRA, what caregivers in the control group do better is the proper management of fever, other actions had fair and poor proper management proportions. Conclusion. Caregivers Knowledge and practices were inadequate, the necessity to implement and reinforce educative actions in the community is shown.

Objetivo. Estabelecer a relação existente entre a Doença Respiratória Aguda (ERA) e os conhecimentos e práticas que tem o responsável de crianças. Metodologia. Estudo de casos e controles em que os casos foram crianças hospitalizadas por ERA e os controles as crianças hospitalizadas por causas diferentes. Realizouse entrevista aos responsáveis das crianças com o fim de indagar o nível de conhecimentos e práticas que tinham com respeito à ERA. Resultados. Estudaram-se 24 casos e 24 controles. O perfil do responsável de ambos os grupos de estudo é o de mulheres, mães do menor, donas de casa, com nível educativo de secundária, filiadas ao regime tributável e de estratos socioeconômicos 2 e superior. Os responsáveis dos casos tiveram menor proporção de conhecimentos adequados envelope ERA do que os dos controles (41.7% contra 75.0%, p=0.02). Um descenso de responsáveis em ambos os grupos identifica adequadamente os signos e sintomas de ERA (casos=4.2% e controles=8.2%). O conhecimento de quando conferir de maneira urgente foi adequado em 75.0% dos responsáveis dos casos contra 66.7% dos responsáveis dos controles. Nas práticas desenvolvidas quando a criança tem ERA os responsáveis dos controles a que mais realizam é o adequado manejo da febre, o resto de práticas tiveram proporções de manejo adequado entre regulares e más. Conclusão. Os conhecimentos e práticas nos responsáveis foram inadequados, se evidência a necessidade de implementar e reforçar ações educativas na comunidade.

Review of Paediatrics In-Patient at Nepal Medical College and Teaching Hospital.

Introduction: This retrospective study was undertaken to analyze the disease pattern in the Pediatric ward in a Medical College. After analyzing the data, our study would emphasize on the prevention and the management modality of the most prevalent diseases in the community. Methodology: This study was carried out retrospectively for one year from January 2008 - December 2008 on the basis of age and sex and the frequency of disease according to the system involved. Results: A total number of 453 patients were admitted during the study period. There were 267(59%) male and 186(41%) female children. Less than five years age group accounted for 180(39.7%) excluding the neonate. In the study period, respiratory tract infections were the commonest cause of admission in all age group 198(43.7%), gastrointestinal including diarrhoeal diseases were 112(24.7%), enteric fever comprised of 22(5%), and other disease comprised of about 143(31.5%) of the total admissions. CNS diseases comprised of 43(9%) of which 7(16%) were meningitis and meningoencephalitis, 26(60%) of the total CNS cases were due to febrile convulsion. Respiratory diseases were found to be the major cause of morbidity in children. Conclusion: Children under five years age being the most common age group amongst all, with infection being the most predominant cause of Pediatric morbidity, the WHO/UNICEF algorithm for Integrated Management of Childhood Illness (IMCI) is specifically suited for the developing country like ours.

Situational analysis of key nutrition and health related household and community practices in rural Baroda, Gujarat - the IMCI approach.

The present study was a situational analysis of household and community practices as per IMCI (Integrated Management of Childhood Illness) framework in rural Baroda, Gujarat. One PHC (Primary Health Centre) was purposively selected and out of the 17 AWCs (Anganwadi Centers) under this PHC, 6 were randomly selected. All households under these 6 AWCs having children less than three years of age were enrolled in the study. Data for knowledge, attitude and practices regarding 12 key family & community practices, nutrition & health services utilization for children and existing perceptions about infant feeding practices was elicited from mothers using a pretested questionnaire and focus group discussions. Results revealed that 38% mothers did not feed colostrum to the child in spite of most of them being advised to do so by TBA and Doctor/ANM (Auxiliary Nurse Midwife). Most households used open areas for waste disposal. Proper disposal of children’s feces was practiced only by 7% of the households. While few mothers knew about ORS packets, none of them knew the correct method of preparation and only 17% of the children with diarrhea in the past 2 weeks were given ORS. About 31% of the pregnant women did not get themselves immunized for TT and most of the deliveries took place at home. Supplementary food was the most frequently used service followed by growth monitoring while other services like preventive health check up were not used at all. The study thus indicates an urgent need to impart appropriate nutrition health education using behaviour change communication strategies.

Childhood morbidity, household practices and health care seeking for sick children in a tribal district of Maharashtra, India.

Objectives: To find out the magnitude of childhood morbidities, health care seeking behavior and explore the status of 'some desired practices' at household level during episodes of illness in two tribal blocks of Chandrapur district. Materials and Methods: The present explanatory mixed-method design of quantitative (survey) and qualitative (focus group discussions, FGDs )methods was undertaken in nine Primary health centers of Warora and Bhadrawati blocks in Chandrapur district. The information of 2,700 under-five children on morbidity, health care seeking behavior and some desired practices at household level was collected by paying home visits and using pre-designed and pre-tested questionnaire. The data was entered and analyzed by using SPSS 12.0.1 and C sample program of epi_info (version 6.04d) software package. The conventional content analysis of FGD data was undertaken. Results: The prevalence of morbidities was high among newborns and children. About 1,811 (67%) children had at least one of the morbidities. Private health care providers and village level faith healers were preferred for seeking treatment of newborn danger sings and childhood morbidities. The status of some desired household practices such as frequent feeding and giving extra fluid to drink during episodes of illness was poor. Conclusions: In conclusion, considering high prevalence of child morbidities and poor status of some desired household practices of caregivers at household level for sick children, household and community IMNCI strategy needs to be implemented to promote child health and nutrition. Apart from this, health care delivery at village level should be strengthened.

IMCI approach in tertiary hospitals, India.

Objective. This study was conducted to compare physicians’ diagnosis with Integrated Management of Childhood Illness (IMCI) algorithm generated diagnosis in hospitalized children aged 2 – 59 months. Methods. Recruited were patients aged 2-59 months admitted with one or more IMCI danger signs. IMCI and physician's diagnosis were noted and compared. Results. In 222 included subjects, mean duration of illness was 9.4 (SD: 16.5) days. Among those with cough or difficult breathing, 44 (19.8%) and 66 (29.7%) were diagnosed as either severe pneumonia or mild to moderate pneumonia by physicians and IMCI algorithm, respectively (p= 0.015). Among 146 presenting as fever, 140 (95.9%) were diagnosed as very severe febrile disease by the IMCI algorithm, whereas physicians diagnosed these as either malaria in 10/146 (6.7%), pyogenic meningitis in 47/146 (32.2%), sepsis in 31/146 (21.3%), tuberculous meningitis in 17/146 (11.6%), encephalitis in 5/146 (3.4%), measles in 3/146 (2.1%) or others in 24/146 (16.4%). Conclusion. As there was a low concordance between physician and IMCI algorithmic diagnosis of pneumonia (Kappa value= 0.74, 95% CI: (0.64 – 0.84)) and since very severe febrile disease is not a diagnosis made by the physicians, the IMCI algorithms have to be refined for appropriate management of these conditions.

Assessment of child health care services in Bac Giang and Ha Nam provinces

Background: The strategy of Integrated Management of Childhood Illness (IMCI) was developed as an approach/tool for reducing the childhood mortality in developing countries. IMCI was approved by the Ministry of Health of Viet Nam and has been implemented in more than 3500 communal health centers nationwide. Aims: 1) To discover the quality of health care services for children under-5 and the situation of IMCI in health facilities. 2) To propose solutions to improve the quality of health care services for children. Materials and method: The cross-sectional study using quantitative and qualitative approaches conducted 58 direct observations in health workers, interviewed 58 caretakers, comprehensively interviewed 20 local leaders and technical staffs, facilitated 12 focal group discussions and reviewed 120 records of 12 commune health centers. Results: IMCI was considered by all of the participants as a comprehensive approach to improving the quality of childhood health care at first-level health facilities. IMCI contributed towards improved case management skills of health workers, improved the supply of essential drugs and supplies for child health care. As a result, the quality of health services for children under-5 has been promoted (93% of illness children were correctly assessed and classified, 84.6% of them were correctly treated and counseled). Health workers in Ly Nhan district, Ha Nam province adhered to 8.4+/-1.5 out of 10 essential steps of comprehensive child health care. Contrarily, this indicator was low in the districts of Bac Giang province (4.8+/-1.5), not much different to untrained IMCI health workers. Conclusion: IMCI is a useful strategy to improving the quality of child health care. But there were some difficulties that affected the implementation of this strategy in first-level health facilities.