EVALUATION OF AN ALGORITHM FOR THE INTEGRATED MANAGEMENT OF CHILDHOODILLNESS IN AN AREA WITH SEASONAL MALARIA IN THE GAMBIA

Most of the 12.4 million deaths occurring every year among under-5-yea r-olds in developing countries could be prevented by the application o f simple treatment strategies. So that health professionals who have h ad limited training can identify and classify the common Childhood dis eases, WHO developed a treatment algorithm (the integrated Management of Childhood Illness (IMCI) or Sick Child algorithm), a prototype of w hich was tested in 440 Gambian children aged between 2 months and 5 ye ars. The children were first assessed by a trained field worker using the algorithm, and then by a paediatrician whose clinical diagnosis wa s supported by laboratory investigations and, when indicated, a chest X-ray. Compared with the paediatrician's diagnosis, the sensitivity an d specificity of the draft IMCI algorithm were, respectively, 81% and 89% for the detection of pneumonia, 67% and 96% for dehydration, 87% a nd 8% for malaria parasitaemia (any level), 100% and 9% for malaria pa rasitaemia (above 5000 parasites/mu l), 100% and 99% for measles, 31% and 97% for otitis media, and 89% and 90%;for malnutrition. Among the children admitted by the physician, 45% had been recommended for admis sion by the algorithm. Intermittent fever, chills and sweats did not h elp in discriminating between malaria and non-malarious fevers; shiver ing or shaking of the body had a sensitivity of only 35%. While the al gorithm dealt with, the majority of presenting complaints, the most co mmon problems not addressed by the chart were skin rashes (21%), mouth problems (8%), and eye problems (6%). The draft IMCI algorithm proved to be effective in the diagnosis of pneumonia, gastroenteritis, measl es and malnutrition, but not malaria where its use without microscopy would result in considerable overtreatment, especially in a low transm ission area or during a low transmission season in countries with seas onal malaria. The current algorithm would benefit from expansion to co ver management of localized infections as well as skin, mouth and eye problems.