Integrated Management of Childhood Illnesses Strategy: Compliance with Referral and Follow-Up Recommendations in Gezira State, Sudan

Article excerpt

Objectives To determine the extent to which families follow referral and follow-up recommendations given in accordance with the Integrated Management of Childhood Illnesses (IMCI) strategy and the factors that influence families' responses to such recommendations.

Methods Children aged 2 months-5 years who presented to an IMCI-trained health worker in Massalamia Health Area, Sudan, were recruited. Children with an IMCl classification that indicated the need for referral or follow-up were traced to determine whether the family complied with the referral or follow-up recommendation. Caretakers were interviewed to find out why they had or had not complied. Focus group discussions were held with health workers, caretakers, and community members.

Findings Overall, 5745 children were enrolled. Of these, 162 (3%) were considered to be in need of urgent referral: 53 (33%) attended a hospital on the day of the referral, with a further 32 (23%) visiting the hospital later than the day of referral. About half of families cited cost as the reason for not visiting a hospital. A total of 1197 (21%) children were classified as needing follow-up. Compliance with a follow-up recommendation was 44% (529 children). Almost 165 (90%) of caretakers who were aware of and did not comply with follow up, said they had not done so because the child was better. Compliance increased with the caretaker's level of education, if drugs were provided during the first visit, and if the follow-up period was short (2 or 5 days).

Conclusion In Massalamia--a resource-constrained environment in which IMCI implementation was well received by the community--only about half of children judged to be in need of urgent referral were taken for that care within 24 hours. Most children in need of follow-up received their first treatment dose in the health facility. This aspect of IMCI was commented upon favourably by caretakers, and it may encourage them to return for follow-up. Rates of return might also improve if return visits for children currently asked to return after 14 or 30 days were scheduled earlier.

Keywords Child health services; Primary health care; Delivery of health care, Integrated; Referral and consultation; Patient compliance; Child; Family; Socioeconomic factors; Sudan (source: MESH, NLM).

Mots cles Service sante infantile; Programme soins courants; Distribution integree soins; Consultation pour avis expert; Observance prescription; Enfant; Famille; Facteurs socio-economiques; Soudan (source: MESH, INSERM).

Palabras clave Servicios de salud infantil; Atencion primaria de salud; Entrega integrada de atencion de salud; Remision y consulta; Cooperacion del paciente; Nino; Familia; Factores socioeconomicos; Sudan (fuente: DeCS, BIREME).

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Bulletin of the World Health Organization 2003;81:708-716

Voir page 714 le resume en francais. En la pagina 714 figura un resumen en espanol.

Resume

Prise en charge integree des maladies de l'enfant : observance des recommandations concernant le transfert et le suivi, dans l'Etat de Gezira (Soudan)

Objectif Determiner dans quelle mesure les familles suivent les recommandations de transfert et de suivi qui leur ont ete donnees conformement aux strategies de la prise en charge integree des maladies de l'enfant (PClME) ; identifier les facteurs qui influent sur la reponse des familles.

Methodes Les enfants de 2 mois a 5 ans vus par un agent de sante forme a la PCIME dans la zone sanitaire de Massalamia (Soudan) ont ete recrutes. Les aidants des enfants chez lesquels un diagnostic correspondant a une classification de la PClME a ete porte ont ete interroges pour determiner si la famille s'est conformee aux recommandations fournies en matiere de transfert et de suivi. Des groupes de discussion ont reuni les soignants, les aidants et des membres de la communaute.

Resultats Au total, 5745 enfants ont ete recrutes. …