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Evaluation of an Algorithm for Integrated Management of Childhood Illness in an Area of Kenya with High Malaria Transmission.

Bulletin of the World Health Organization(1997)SCI 1区

Division of Bacterial and Mycotic Diseases

Cited 36|Views15
Abstract
In 1993, the World Health Organization completed the development of a draft algorithm for the integrated management of childhood illness (IMCI), which deals with acute respiratory infections, diarrhoea, malaria, measles, ear infections, malnutrition, and immunization status. The present study compares the performance of a minimally trained health worker to make a correct diagnosis using the draft IMCI algorithm with that of a fully trained paediatrician who had laboratory and radiological support. During the 14-month study period, 1795 children aged between 2 months and 5 years were enrolled from the outpatient paediatric clinic of Siaya District Hospital in western Kenya; 48% were female and the median age was 13 months. Fever, cough and diarrhoea were the most common chief complaints presented by 907 (51%), 395 (22%), and 199 (11%) of the children, respectively; 86% of the chief complaints were directly addressed by the IMCI algorithm. A total of 1210 children (67%) had Plasmodium falciparum infection and 1432 (80%) met the WHO definition for anaemia (haemoglobin < 11 g/dl). The sensitivities and specificities for classification of illness by the health worker using the IMCI algorithm compared to diagnosis by the physician were: pneumonia (97% sensitivity, 49% specificity); dehydration in children with diarrhoea (51%, 98%); malaria (100%, 0%); ear problem (98%, 2%); nutritional status (96%, 66%); and need for referral (42%, 94%). Detection of fever by laying a hand on the forehead was both sensitive and specific (91%, 77%). There was substantial clinical overlap between pneumonia and malaria (n = 895), and between malaria and malnutrition (n = 811). Based on the initial analysis of these data, some changes were made in the IMCI algorithm. This study provides important technical validation of the IMCI algorithm, but the performance of health workers should be monitored during the early part of their IMCI training.
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要点】:本研究在肯尼亚西部地区评估了世界卫生组织制定的针对儿童疾病综合管理(IMCI)草案算法的效果,发现经过最少培训的健康工作者使用该算法进行正确诊断的性能可以与有实验室和放射支持的全科培训儿科医生相媲美。

方法】:通过对比最少培训的健康工作者使用IMCI算法进行疾病分类与接受实验室和放射学支持的儿科医生的诊断结果,评估算法的有效性。

实验】:在为期14个月的研究中,对西肯尼亚Siaya区医院儿科门诊的1795名2个月至5岁儿童进行了登记,使用IMCI算法对健康工作者的诊断性能进行了测试,数据集名称未在文中提及,结果显示算法在一些疾病分类上具有高敏感性,但在特异性方面有差异,经过初步数据分析后对IMCI算法进行了修改。