Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis

BACKGROUND: An estimated 6.9 million children die annually in low and middle-income countries because of treatable illneses including pneumonia, diarrhea, and malaria. To reduce morbidity and mortality, the Integrated Management of Childhood Illness strategy was developed, which included a component...

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Autores principales: Nguyen, Duyen Thi Kim, Leung, Karen K., McIntyre, Lynn, Ghali, William A., Sauve, Reg
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680429/
https://www.ncbi.nlm.nih.gov/pubmed/23776599
http://dx.doi.org/10.1371/journal.pone.0066030
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author Nguyen, Duyen Thi Kim
Leung, Karen K.
McIntyre, Lynn
Ghali, William A.
Sauve, Reg
author_facet Nguyen, Duyen Thi Kim
Leung, Karen K.
McIntyre, Lynn
Ghali, William A.
Sauve, Reg
author_sort Nguyen, Duyen Thi Kim
collection PubMed
description BACKGROUND: An estimated 6.9 million children die annually in low and middle-income countries because of treatable illneses including pneumonia, diarrhea, and malaria. To reduce morbidity and mortality, the Integrated Management of Childhood Illness strategy was developed, which included a component to strengthen the skills of health workers in identifying and managing these conditions. A systematic review and meta-analysis were conducted to determine whether IMCI training actually improves performance. METHODS: Database searches of CIHAHL, CENTRAL, EMBASE, Global Health, Medline, Ovid Healthstar, and PubMed were performed from 1990 to February 2013, and supplemented with grey literature searches and reviews of bibliographies. Studies were included if they compared the performance of IMCI and non-IMCI health workers in illness classification, prescription of medications, vaccinations, and counseling on nutrition and admistration of oral therapies. Dersminion-Laird random effect models were used to summarize the effect estimates. RESULTS: The systematic review and meta-analysis included 46 and 26 studies, respectively. Four cluster-randomized controlled trials, seven pre-post studies, and 15 cross-sectional studies were included. Findings were heterogeneous across performance domains with evidence of effect modification by health worker performance at baseline. Overall, IMCI-trained workers were more likely to correctly classify illnesses (RR = 1.93, 95% CI: 1.66–2.24). Studies of workers with lower baseline performance showed greater improvements in prescribing medications (RR = 3.08, 95% CI: 2.04–4.66), vaccinating children (RR = 3.45, 95% CI: 1.49–8.01), and counseling families on adequate nutrition (RR = 10.12, 95% CI: 6.03–16.99) and administering oral therapies (RR = 3.76, 95% CI: 2.30–6.13). Trends toward greater training benefits were observed in studies that were conducted in lower resource settings and reported greater supervision. CONCLUSION: Findings suggest that IMCI training improves health worker performance. However, these estimates need to be interpreted cautiously given the observational nature of the studies and presence of heterogeneity.
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spelling pubmed-36804292013-06-17 Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis Nguyen, Duyen Thi Kim Leung, Karen K. McIntyre, Lynn Ghali, William A. Sauve, Reg PLoS One Research Article BACKGROUND: An estimated 6.9 million children die annually in low and middle-income countries because of treatable illneses including pneumonia, diarrhea, and malaria. To reduce morbidity and mortality, the Integrated Management of Childhood Illness strategy was developed, which included a component to strengthen the skills of health workers in identifying and managing these conditions. A systematic review and meta-analysis were conducted to determine whether IMCI training actually improves performance. METHODS: Database searches of CIHAHL, CENTRAL, EMBASE, Global Health, Medline, Ovid Healthstar, and PubMed were performed from 1990 to February 2013, and supplemented with grey literature searches and reviews of bibliographies. Studies were included if they compared the performance of IMCI and non-IMCI health workers in illness classification, prescription of medications, vaccinations, and counseling on nutrition and admistration of oral therapies. Dersminion-Laird random effect models were used to summarize the effect estimates. RESULTS: The systematic review and meta-analysis included 46 and 26 studies, respectively. Four cluster-randomized controlled trials, seven pre-post studies, and 15 cross-sectional studies were included. Findings were heterogeneous across performance domains with evidence of effect modification by health worker performance at baseline. Overall, IMCI-trained workers were more likely to correctly classify illnesses (RR = 1.93, 95% CI: 1.66–2.24). Studies of workers with lower baseline performance showed greater improvements in prescribing medications (RR = 3.08, 95% CI: 2.04–4.66), vaccinating children (RR = 3.45, 95% CI: 1.49–8.01), and counseling families on adequate nutrition (RR = 10.12, 95% CI: 6.03–16.99) and administering oral therapies (RR = 3.76, 95% CI: 2.30–6.13). Trends toward greater training benefits were observed in studies that were conducted in lower resource settings and reported greater supervision. CONCLUSION: Findings suggest that IMCI training improves health worker performance. However, these estimates need to be interpreted cautiously given the observational nature of the studies and presence of heterogeneity. Public Library of Science 2013-06-12 /pmc/articles/PMC3680429/ /pubmed/23776599 http://dx.doi.org/10.1371/journal.pone.0066030 Text en © 2013 Nguyen et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Nguyen, Duyen Thi Kim
Leung, Karen K.
McIntyre, Lynn
Ghali, William A.
Sauve, Reg
Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis
title Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis
title_full Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis
title_fullStr Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis
title_full_unstemmed Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis
title_short Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis
title_sort does integrated management of childhood illness (imci) training improve the skills of health workers? a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680429/
https://www.ncbi.nlm.nih.gov/pubmed/23776599
http://dx.doi.org/10.1371/journal.pone.0066030
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