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Integrated management of childhood illness: field test of the WHO / UNICEF training course in Arusha, United Republic of Tanzania. WHO Division of Child Health and Development and WHO Regional Office for Africa.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1997; 75 Suppl 1:55-64.The World Health Organization/UNICEF training course on the integrated management of childhood illness (IMCI) for health workers in developing countries was field tested in Arusha, Tanzania, during February-March 1995 to determine whether it could effectively prepare participants to correctly manage sick children and to suggest improvements in course materials and teaching procedures. The 11-day course was tested upon the most peripheral first-level facility health workers: 8 medical assistants, 8 rural medical aides, and 7 maternal-child health (MCH) aides. Each trainee individually examined 9-10 inpatients and managed more than 30 sick children as outpatients. While some trainees had problems reading the training modules in English, all 3 groups overall could assess, classify, and treat most sick children by the end of the course. Most were also able to provide adequate counseling. Improvements were suggested and incorporated into the course guidelines and training materials.
In: National Council for International Health [NCIH]. New developments in tropical medicine. Washington, D.C., NCIH, 1982 Jan. 63-8.Death from acute diarrhea is most often due to dehydration which results from the excessive loss of water and salts from the extracellular fluid space. Clinical signs of progressive dehydration in children with diarrhea include dry mouth and tongue, absence of tears, sunken eyes or interior fontanelle (in infants), oliguria or anuria, decreased skin elasticity, muscle cramps and abdominal distention and eventually deep and rapid respiration, fast and weak pulse, hypotension, shock, and coma. Replacement of fluids and electrolytes, orally or intravenously, is the only effective treatment for dehydration; if a patient is given an adequate volume of oral glucose-electrolyte solution, diarrheal stool losses can be fully replaced and fluid balance maintained. The World Health Organization's oral rehydration (OR) formula consists of 3.5 g sodium chloride, and 20 g glucose; it has been proven to be safe and effective for all age groups, including neonates. The following steps should be taken in managing diarrheal dehydration: 1) evaluate the patient by rapid physical examination and history, 2) calculate oral fluid requirements, 3) after the intake of fluids, reassess and weigh patient, and 4) breast milk of 1/2-1/4 strength formula milk should be given and OR therapy should be continued as long as the child has diarrhea. The best means of supplying OR solution to most people would be to encourage home use, although problems exist with incorrect mixing of the solution and improper ingredients being used. OR packets can be produced locally. Cost will vary and distribution will require an effective system. Training personnel, village workers, and family workers, however, is the biggest challenge. Presentation of diarrhea requires environmental changes such as food, refrigeration, better personal hygiene, and improved housing, which are all costly. Efforts to promote breast feeding and increase health education about weaning practices and diarrhea prevention need to be increased.