Most of the 12.4 million deaths occurring every year among under-5-year-olds in developing countries could be prevented by the application of simple treatment strategies. So that health professionals who have had limited training can identify and classify the common childhood diseases, WHO developed a treatment algorithm (the Integrated Management of Childhood Illness (IMCI) or Sick Child algorithm), a prototype of which was tested in 440 Gambian children aged between 2 months and 5 years. The children were first assessed by a trained field worker using the algorithm, and then by a paediatrician whose clinical diagnosis was supported by laboratory investigations and, when indicated, a chest X-ray. Compared with the paediatrician's diagnosis, the sensitivity and specificity of the draft IMCI algorithm were, respectively, 81% and 89% for the detection of pneumonia, 67% and 96% for dehydration, 87% and 8% for malaria parasitaemia (any level), 100% and 9% for malaria parasitaemia (above 5000 parasites/microliter), 100% and 99% for measles, 31% and 97% for otitis media, and 89% and 90% for malnutrition. Among the children admitted by the physician, 45% had been recommended for admission by the algorithm. Intermittent fever, chills and sweats did not help in discriminating between malaria and non-malarious fevers; shivering or shaking of the body had a sensitivity of only 35%. While the algorithm dealt with the majority of presenting complaints, the most common problems not addressed by the chart were skin rashes (21%), mouth problems (8%), and eye problems (6%). The draft IMCI algorithm proved to be effective in the diagnosis of pneumonia, gastroenteritis, measles and malnutrition, but not malaria where its use without microscopy would result in considerable over-treatment, especially in a low transmission area or during a low transmission season in countries with seasonal malaria. The current algorithm would benefit from expansion to cover management of localized infections as well as skin, mouth and eye problems.
PIP: Most mortality among children under age 5 years in developing countries could be prevented through the application of simple treatment strategies. To that end, the World Health Organization (WHO) developed the Integrated Management of Childhood Illness (IMCI) treatment algorithm to help health professionals who have had only limited training identify and classify common childhood diseases. A prototype of the IMCI was tested among 440 Gambian children aged 2 months to 5 years. The children were first assessed by a trained field worker using the algorithm, then by a pediatrician whose clinical diagnosis was supported by laboratory investigations and, when indicated, a chest X-ray. The draft IMCI algorithm was 81% sensitive and 89% specific for the detection of pneumonia compared with the physician's diagnosis; 67% and 96%, respectively, for dehydration; 87% and 8% for malaria parasitemia at any level; 100% and 9% for malaria parasitemia above 5000 parasites per mcl; 100% and 99% for measles; 31% and 97% for otitis media; and 89% and 90% for malnutrition. 45% of the children admitted by the physicians had been recommended for admission by the algorithm. While the algorithm addressed the majority of presenting complaints, skin rashes and mouth and eye problems were overlooked.