Treatment in Kenyan rural health facilities: projected drug costs using the WHO-UNICEF integrated management of childhood illness (IMCI) guidelines

Guidelines for the integrated management of childhood illness (IMCI) in per ipheral health facilities have been developed by WHO and UNICEF to improve the recognition and treatment of common causes of childhood death. To evalu ate the impact of the guidelines on treatment costs, we compared the cost o f drugs actually prescribed to a sample of 747 sick children aged 2-59 mont hs in rural health facilities in western Kenya with the cost of drugs had t he children been managed using the IMCI guidelines. The average cost of drugs actually prescribed per child was US$ 0.44 (1996 US$). Antibiotics were the most costly component, with phenoxymethylpenicil lin syrup accounting for 59% of the cost of all the drugs prescribed. Of th e 295 prescriptions for phenoxymethylpenicillin syrup, 223 (76%) were for t reatment of colds or cough. The cost of drugs that would have been prescrib ed had the same children been managed with the IMCI guidelines ranged from USE 0.16 per patient (based on a formulary of larger-dose tablets and a hom e remedy for cough) to US$ 0.39 per patient (based on a formulary of syrups or paediatric-dose tablets and a commercial cough preparation). Treatment of coughs and colds with antibiotics is not recommended in the Ke nyan or in the IMCI guidelines. Compliance with existing treatment guidelin es for the management of acute respiratory infections would have halved the cost of the drugs prescribed. The estimated cost of the drugs needed to tr eat children using the IMCI guidelines was less than the cost of the drugs actually prescribed, but varied considerably depending on the dosage forms and whether a commercial cough preparation was used.