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 curr ently being implemented by a number of countries worldwide. This is th e second report from a study in western Uganda comparing the assessmen t and classification of disease by medical assistants using the IMCI a lgorithm with that of hospital-based general medical officers, who use d their clinical judgement to assess and provide treatment. Treatment prescribed by the hospital medical officers was compared to that indic ated by IMCI disease classifications. The study population comprised 1 226 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 classifica tions had been used to decide on hospital referral, 37 children who me t IMCI criteria for referral would have been sent home. Consultations took on average 7.2 min, longer than usual for several African countri es. Use of the IMCI guidelines would have referred 16.2% of children t o 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 c ompared to the treatment cost of US$0.82 as prescribed by medical offi cers. 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 d istrict hospital, using the IMCI algorithm would bring major changes i n pharmaceutical use and referral practices. However, there is concern about the difficulty medical assistants had in using it, and the pote ntial for longer consultation times.