THE INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS IN WESTERN UGANDA

Bringing together various disease-specific guidelines for sick childre n, WHO and UNICEF have developed an Integrated Management of Childhood Illness (IMCI) algorithm, one component of which (assess and classify ) was tested in the outpatient department of a rural district hospital in western Uganda. Children aged 2-59 months were seen first by a Uga ndan medical assistant trained in IMCI, and then evaluated by a medica l officer. Sensitivity specificity and positive predictive values were determined by comparing the IMCI classifications with a reference sta ndard based on the medical officers' diagnoses and laboratory tests. O f the 1226 children seen, 69% were classified into more than one sympt om category, 7% were not classified in any symptom category, 8% had a danger sign, and 16% were classified into a severe category, for which the IMCI approach recommended urgent hospital referral. Specificity f or most classifications was good, though sensitivity and positive pred ictive values were variable. We conclude that the IMCI algorithm is an important advance in the primary care of sick children in developing countries.