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Diagnosis and management of febrile children using the WHO / UNICEF guidelines for IMCI in Dhaka, Bangladesh.
Bulletin of the World Health Organization. 2001; 79(12):1096-105.In Dhaka, Bangladesh, a study was conducted to determine the effectiveness of WHO’s integrated management of childhood illnesses (IMCI) guidelines in identifying children with bacterial infections in need of antibiotics. A systematic sample of 669 sick children aged 2-59 months was enrolled in the study. Weight, tactile, measured temperature, and respiratory rate were obtained from each patient. The study revealed that had IMCI guidelines been used to evaluate the subjects, 78% of those with bacterial infections would have received antibiotics, including the majority of children with meningitis (100%), pneumonia (95%), otitis media (95%), urinary tract infection (83%), bacteremia (50%), dysentery (48%), and skin infections (30%). It was also noted that the fever module identified only one additional case of meningitis. Children with bacteraemia were more likely to be febrile, feel hot and have history of fever than those with dysentery and skin infections. Fever combined with parental perception of fast breathing provided a more sensitive fever module for the detection of bacteraemia than the current ICMI module. In an area of low malaria prevalence, the IMCI guidelines provide antibiotics to the majority of children with bacterial infections, but improvements in the fever module are possible.