Abstract:
BACKGROUND. Integrated Management of Childhood Illness (IMCI) is an essential strategy known to deliver childhood interventions that
reduce the under-five mortality rate.
Objective. To evaluate the adherence to the IMCI case management guidelines by primary healthcare workers in the Tshwane area, South Africa.
METHODS. The study was conducted between July and December 2012 on children referred from clinics to Kalafong Hospital. Data on IMCI
clinical symptoms and signs, classification and treatment given at the clinics before referral to the hospital were collected from patients’
referral letters. An interview with the caregiver on counselling received at the clinic was done using an adapted World Health Organization
health facility survey tool.
RESULTS. Eighty children between 2 and 60 months referred from 12 local clinics were included in the study. IMCI classification was done
in just over half (52.9%) of 34 children with cough and 73% of 15 children with diarrhoea. Only 18% of children with chest indrawing and
fast breathing were classified correctly. Prereferral treatment for all children with severe dehydration had been given correctly but not so
for children with severe pneumonia and severe malnutrition. None of the children with severe disease had been checked for glucose levels
before referral.
CONCLUSIONS. The IMCI guidelines had not been adhered to in all children referred to the hospital. Children, particularly those with
severe disease, had been incorrectly classified, leading to inadequate prereferral treatment. Healthcare workers had not given the expected
treatment at the clinic before referral.
