The Implementation of the Integrated Management of Childhood Illnesses Can Improve the Management of HIV by Peripheral Health Workers

Félicitée Nguefack, Suzanne Ngo Um, Evelyn Mah, Oliver Azinui, Valery Forbuzo Achu, R Dongmo

Abstract


ABSTRACT
Context. The Integrated Management of Childhood Illnesses (IMCI) aims to reduce death, illness, disability, and to promote improved growth and development of children < 5years. Our objective was to assess the effectiveness of IMCI as a tool to facilitate diagnosis of HIV. Method. This was a cross sectional observational study. We interviewed health workers (HWs) on IMCI and observed them during the assessment of at least five patients in 14 health facilities. An IMCI trainer then reassessed the children to confirm the conclusions made. Variables studied were: training, skill in IMCI, difficulty and suggestions to improve IMCI. HIV assessment was based on signs called “5 entry door” on which are based the classification and management of cases. Results. 30 workers were included; 43.8% of HWs had less than two years in the service, and 53.3% were not trained. Most of HWs (85.7%) not formerly trained were implementing the IMCI. They demonstrated various abilities to correctly manage. Among the untrained, 8 (66.6%) against 16 (100%) trained HWs adequately assessed, classified and managed children following the algorithm for HIV. Most of them (72.2%) declared that the IMCI facilitates early consultation. Majority (94.6%) had difficulty in implementing the algorithm due lack of material, training, supervision and motivation. Conclusion. The IMCI algorithm is a tool that can facilitate the identification of HIV infection. In a context where the check-treat strategy is not wide spread and where the PMTCT failed to detect all the infected/exposed children, routine implementation of the IMCI can improve the HIV management program.

RÉSUMÉ
Introduction. La Prise en Charge Intégrée des Maladies de l’Enfant (PCIME) vise à réduire la morbidité, les décès et l’infirmité des enfants < 5 ans. L’étude visait à évaluer l’efficacité de l’outil PCIME dans le dépistage du VIH. Méthodologie. L’étude était transversale descriptive. Nous avons interviewé sur la PCIME et observé des personnels prenant en charge chacun au moins cinq patients dans 14 formations sanitaires. Un expert réévaluait les enfants afin d’approuver leurs conclusions. Les variables étudiées étaient : la formation, maitrise des directives PCIME, difficultés et les suggestions pour son amélioration. La recherche du VIH reposait sur les signes nommés « 5 portes d’entrée » desquelles découlent la classification et le traitement. Résultats. 30 personnels de santé ont été inclus. 43,8% de ces prestataires avaient moins de deux ans de service et 53,3% n’étaient pas formés. La majorité (85,7%) du personnel non formé pratiquait la PCIME. Ils étaient capables de prendre en charge correctement un enfant selon l’algorithme du VIH, de façon variable. Parmi eux, 8 (66,6%) contre 16 (100%) formés pouvaient correctement évaluer, classer et traiter les enfants. La plupart (72,2%) déclaraient que la PCIME facilite la consultation précoce. Presque tous (94,6%) éprouvaient des difficultés pour l’implémenter à cause du défaut d’outils de formation, de supervision et de motivation. Conclusion. L’algorithme PCIME représente un outil qui faciliterait l’identification de l’infection à VIH. Dans un contexte où son dépistage systématique n’est pas vulgarisé et où les performances de la PTME ne permettent pas de détecter tous les enfants exposés/infectés, son implémentation systématique améliorerait le programme du VIH.


Keywords


IMCI, assessment, HIV/aids, children.

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