Potential implications of the integrated management of childhood illness (IMCI) for hospital referral and pharmaceutical usage in western Uganda

The integrated management of childhood illness approach (IMCI) is currently being implemented by a number of countries worldwide. This is the second report from a study in western Uganda comparing the assessment and classification of disease by medical assistants using the IMCI algorithm with that of hospital-based general medical officers, who used their clinical judgement to assess and provide treatment. Treatment prescribed by the hospital medical officers was compared to that indicated by IMCI disease classifications. The study population comprised 1226 children aged 2-59 months. Medical assistants had some difficulty in completing the IMCI assessment, leading to incorrect classification of findings in 138 of 1086 completed forms (13%). If their classifications had been used to decide on hospital referral, 37 children who met IMCI criteria for referral would have been sent home. Consultations took on average 7.2 min, longer than usual for several African countries. Use of the IMCI guidelines would have referred 16.2% of children to hospital, compared with 22% referred by the medical officers. Use of IMCI could have reduced the cost of medication to US$0.17 per child compared to the treatment cost of US$0.82 as prescribed by medical officers. Medical officers prescribed both a greater number and a greater variety of drugs than indicated by the IMCI algorithm. Compared to the present management of sick children by medical officers at Kabarole district hospital, using the IMCI algorithm would bring major changes in pharmaceutical use and referral practices. However, there is concern about the difficulty medical assistants had in using it, and the potential for longer consultation times.