Assessment of Validity and Reliability of IMNCI Algorithm in Comparison to Provisional Diagnosis of Senior Pediatricians in a Tertiary Hospital of Kolkata

BACKGROUND: Integrated management of childhood illness (IMNCI) is already operational in many states of India, but there are only limited studies in Indian scenario comparing its validity and reliability with the decisions of pediatricians. Aims and OBJECTIVES: To assess the validity and reliability of the IMNCI algorithm with provisional diagnosis of senior pediatricians for each IMNCI classifications. MATERIALS AND METHODS: The present study is done with all the young infants between 0-2 months presented during the study period with a fresh episode of illness to test the validity and reliability of the algorithm in comparison to provisional diagnoses of senior pediatricians. The study was done in a tertiary care hospital. Validity characteristics such as sensitivity, specificity, positive predictive value, negative predictive value, and reliability characteristics such as percent agreement and Kappa were assessed for individual IMNCI classifications. RESULTS: The sensitivity of possible serious bacterial infection, local bacterial infection, jaundice, no dehydration and possible serious bacterial infection, not able to feed were 88.89, 14.29, 66.67, 25 and 44.44% respectively. The specificities for the same conditions were 71.72, 99.09, 99.07, 94.50 and 86.87%. Percent agreements for similar conditions were 74, 94, 97, 90 and 80% respectively and the Kappa ratios were 0.38, 0.20, 0.73, 0.19 and 0.29 respectively. CONCLUSION: It could be concluded that IMNCI is quite a sensitive strategy and could identify severe illnesses of young infants requiring referral to higher facility. Further studies, particularly in primary health care setting, are required.