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A Comparative Study of the Management Decisions by IMNCI Algorithm and by Pediatricians of a Teaching Hospital for the Children Between 2 Months to 5 Years

BACKGROUND: Integrated management of neonatal and childhood illness (IMNCI) is already operational in many states of India, but there are very few studies in Indian scenario comparing its validity and reliability with the pediatricians’ decisions. OBJECTIVES: 1) To compare the IMNCI decision with th...

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Autores principales: Bhattacharyya, Agnihotri, Chatterjee, Chitra, Chatterjee, Sukanta, Dasgupta, Samir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483511/
https://www.ncbi.nlm.nih.gov/pubmed/23112444
http://dx.doi.org/10.4103/0970-0218.99923
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author Bhattacharyya, Agnihotri
Chatterjee, Chitra
Chatterjee, Sukanta
Dasgupta, Samir
author_facet Bhattacharyya, Agnihotri
Chatterjee, Chitra
Chatterjee, Sukanta
Dasgupta, Samir
author_sort Bhattacharyya, Agnihotri
collection PubMed
description BACKGROUND: Integrated management of neonatal and childhood illness (IMNCI) is already operational in many states of India, but there are very few studies in Indian scenario comparing its validity and reliability with the pediatricians’ decisions. OBJECTIVES: 1) To compare the IMNCI decision with the decision of pediatricians; 2) to assess the significance of multiple presenting symptoms in the IMNCI algorithm. MATERIALS AND METHODS: The study was conducted among the sick children between 2 months to 5 years presented in pediatric department from January to March 2009. The IMNCI decision was compared with pediatrician's decisions by percent agreement, Kappa and weighted Kappa with the aids of SPSS version 10. RESULTS: The overall diagnostic agreement between IMNCI algorithm and pediatrician's decisions was 36.64%, (Kappa 0.16 and weighted Kappa 0.29) with 51.15% over diagnosis and 12.21% under diagnosis. The importance given by IMNCI algorithm in cases of multiple presenting symptoms was also reflected as it was evident that 37.50% children presented with three symptoms were categorized as red, whereas it was 28.57% and 11.67% for those presented with two and one symptom, respectively, (P < 0.0001). Pediatricians also gave importance for presence of multiple symptoms by considering 50% as admissible in the group presented with three symptoms, 30.16% in the group presented with two symptoms, and 16.67% in the group presented with only one symptom. The association was also statistically significant (P = 0.018). CONCLUSION: Diagnostic discordance is seen mainly due to over diagnosis of all fever cases as malaria. Importance of presence of comorbidities was also reflected.
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spelling pubmed-34835112012-10-30 A Comparative Study of the Management Decisions by IMNCI Algorithm and by Pediatricians of a Teaching Hospital for the Children Between 2 Months to 5 Years Bhattacharyya, Agnihotri Chatterjee, Chitra Chatterjee, Sukanta Dasgupta, Samir Indian J Community Med Original Article BACKGROUND: Integrated management of neonatal and childhood illness (IMNCI) is already operational in many states of India, but there are very few studies in Indian scenario comparing its validity and reliability with the pediatricians’ decisions. OBJECTIVES: 1) To compare the IMNCI decision with the decision of pediatricians; 2) to assess the significance of multiple presenting symptoms in the IMNCI algorithm. MATERIALS AND METHODS: The study was conducted among the sick children between 2 months to 5 years presented in pediatric department from January to March 2009. The IMNCI decision was compared with pediatrician's decisions by percent agreement, Kappa and weighted Kappa with the aids of SPSS version 10. RESULTS: The overall diagnostic agreement between IMNCI algorithm and pediatrician's decisions was 36.64%, (Kappa 0.16 and weighted Kappa 0.29) with 51.15% over diagnosis and 12.21% under diagnosis. The importance given by IMNCI algorithm in cases of multiple presenting symptoms was also reflected as it was evident that 37.50% children presented with three symptoms were categorized as red, whereas it was 28.57% and 11.67% for those presented with two and one symptom, respectively, (P < 0.0001). Pediatricians also gave importance for presence of multiple symptoms by considering 50% as admissible in the group presented with three symptoms, 30.16% in the group presented with two symptoms, and 16.67% in the group presented with only one symptom. The association was also statistically significant (P = 0.018). CONCLUSION: Diagnostic discordance is seen mainly due to over diagnosis of all fever cases as malaria. Importance of presence of comorbidities was also reflected. Medknow Publications & Media Pvt Ltd 2012 /pmc/articles/PMC3483511/ /pubmed/23112444 http://dx.doi.org/10.4103/0970-0218.99923 Text en Copyright: © Indian Journal of Community Medicine http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Bhattacharyya, Agnihotri
Chatterjee, Chitra
Chatterjee, Sukanta
Dasgupta, Samir
A Comparative Study of the Management Decisions by IMNCI Algorithm and by Pediatricians of a Teaching Hospital for the Children Between 2 Months to 5 Years
title A Comparative Study of the Management Decisions by IMNCI Algorithm and by Pediatricians of a Teaching Hospital for the Children Between 2 Months to 5 Years
title_full A Comparative Study of the Management Decisions by IMNCI Algorithm and by Pediatricians of a Teaching Hospital for the Children Between 2 Months to 5 Years
title_fullStr A Comparative Study of the Management Decisions by IMNCI Algorithm and by Pediatricians of a Teaching Hospital for the Children Between 2 Months to 5 Years
title_full_unstemmed A Comparative Study of the Management Decisions by IMNCI Algorithm and by Pediatricians of a Teaching Hospital for the Children Between 2 Months to 5 Years
title_short A Comparative Study of the Management Decisions by IMNCI Algorithm and by Pediatricians of a Teaching Hospital for the Children Between 2 Months to 5 Years
title_sort comparative study of the management decisions by imnci algorithm and by pediatricians of a teaching hospital for the children between 2 months to 5 years
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483511/
https://www.ncbi.nlm.nih.gov/pubmed/23112444
http://dx.doi.org/10.4103/0970-0218.99923
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