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    Peer Reviewed

    Evaluation of the WHO / UNICEF algorithm for integrated management of childhood illness between the ages of one week to two months.

    Gupta R; Sachdev HP; Shah D

    Indian Pediatrics. 2000 Apr; 37:383-90.

    This prospective observational study aimed to evaluate the utility of the WHO/UN International Children's Emergency Fund algorithm for integrated management of childhood illness (IMCI) between the ages of 1 week-2 months admitted at the outpatient department and emergency room of a medical college hospital. 129 infants presenting to the outpatient department (n = 70) or emergency room (n = 59) were assessed and classified as per IMCI algorithm and treatment required was identified…The final diagnoses made and therapies instituted on this basis served as a 'gold standard.’ The diagnostic and therapeutic agreement between the 'gold standard' and the IMCI was computed. More than one illness was present in 97 (75.2%) of subjects as per 'gold standard' (mean 2.1). Subjects having any referral criteria as per IMCI algorithm had a greater (p = 0.002) co- existence of illnesses (mean 2.3 vs. 1.8 illnesses per child, respectively). The IMCI algorithm covered the majority (81-84%) of the recorded diagnoses either partly (40-41%) or fully (40-44%)…A total agreement with IMCI was found in 60-66% cases… Upper respiratory infection (URI) emerged as an important cause resulting in unnecessary referrals (13 out of 21 cases). Of the 43 cases identified as diarrhea by the algorithm, 6 had breastfed stools, which do not require any therapy. The IMCI algorithm had a provision for preventive services of immunization and breast-feeding counseling (18% possibility of availing missed opportunities in both). There is a sound scientific basis for adopting IMCI approach even in young infants as co-existence of morbidities is frequent and severe illnesses are assessed with good sensitivity. However, there is a need to improve the specificity of referral criteria. Two important conditions identified for possible refinement are URI and breastfed stools. (author's, modified)
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