Does shortening the training on Integrated Management of Childhood Illness guidelines reduce its effectiveness? A systematic review

Bibliographic Data

ID14668166
AuthorsAlexander K Rowe (0000-0002-1383-4341, 1 Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 3World Health Organization—formerly Headquarters, Geneva, Switzerland, now Regional Office Southeast Asia, Delhi, India and 4Department of Child and Adolescent Health and Development, World Health Organi), Samantha Y Rowe (0000-0003-3729-579X, 1 Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 3World Health Organization—formerly Headquarters, Geneva, Switzerland, now Regional Office Southeast Asia, Delhi, India and 4Department of Child and Adolescent Health and Development, World Health Organi), Kathleen A Holloway, Kathleen Holloway (0000-0001-5032-6357, 1 Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 3World Health Organization—formerly Headquarters, Geneva, Switzerland, now Regional Office Southeast Asia, Delhi, India and 4Department of Child and Adolescent Health and Development, World Health Organi), Verica Ivanovska (1 Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 3World Health Organization—formerly Headquarters, Geneva, Switzerland, now Regional Office Southeast Asia, Delhi, India and 4Department of Child and Adolescent Health and Development, World Health Organi), Lulu Muhe (0000-0002-2776-9923, 1 Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 3World Health Organization—formerly Headquarters, Geneva, Switzerland, now Regional Office Southeast Asia, Delhi, India and 4Department of Child and Adolescent Health and Development, World Health Organi), Thierry Lambrechts (1 Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 3World Health Organization—formerly Headquarters, Geneva, Switzerland, now Regional Office Southeast Asia, Delhi, India and 4Department of Child and Adolescent Health and Development, World Health Organi)
Year2012
Volume27
Issue3
Pages179-193
Publication date2012-05-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (OUP) (PUBLISHER)
DOI10.1093/heapol/czr033
PMID21515912
LanguageEN
Citations received10
References cited24

Objective Implementation of the Integrated Management of Childhood Illness (IMCI) strategy with an 11-day training course for health workers improves care for ill children in outpatient settings in developing countries. The 11-day course duration is recommended by the World Health Organization, which developed IMCI. Our aim was to determine if shortening the training (to reduce cost) reduces its effectiveness. Methods We conducted a systematic review to compare IMCI's effectiveness with standard training (duration ≥11 days) versus shortened training (5–10 days). Studies were identified from a search of MEDLINE, two existing systematic reviews, and by contacting investigators. We included published or unpublished studies that evaluated IMCI's effectiveness in developing countries and reported quantitative measures of health worker practices related to managing ill children under 5 years old in public or private health facilities. Summary measures were the median of effect sizes for all outcomes from a given study, and the percentage of patients needing oral antimicrobials or rehydration who were treated according to IMCI guidelines. Findings Twenty-nine studies were included. Direct comparisons from three studies showed little difference between standard and shortened training. Indirect comparisons from 26 studies revealed that effect sizes for standard training versus no IMCI were greater than shortened training versus no IMCI. Across all comparisons, differences ranged from -3 to +23 percentage-points, and our best estimate was a 2 to 16 percentage-point advantage for standard training. No result was statistically significant. After IMCI training (of any duration), 34% of ill children needing oral antimicrobials or rehydration were not receiving these treatments according to IMCI guidelines. Conclusions Based on limited evidence, standard IMCI training seemed more effective than shortened training, although the difference might be small. As sizable performance gaps often existed after IMCI training, countries should consider implementing other interventions to support health workers after training, regardless of training duration

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