REVIEW OF INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) IN EUROPE
By: Susanne Carai Aigul Kuttumuratova Martin Weber
CONTENTS ............................................................................................................. iii Acknowledgements ............................................................................................... iv Study team .......................................................................................................... iv Report-writing team .............................................................................................. iv Acronyms................................................................................................................ v Executive summary ............................................................................................... vi Background .......................................................................................................... vi Objectives ............................................................................................................ vi Methodology ........................................................................................................ vi Findings .............................................................................................................. vii Conclusion and way forward ................................................................................... x Review of Integrated Management of Childhood Illness (IMCI) in Europe ........... 1 Background ........................................................................................................... 1 Objectives ............................................................................................................. 2 Methodology ......................................................................................................... 2 Findings ................................................................................................................ 4 Taking a closer look: IMCI and the use of antibiotics ............................................... 18 Proposed improvements of IMCI ........................................................................... 20 Discussion ........................................................................................................... 20 Further reflection on review findings: children’s rights ............................................. 23 Conclusion........................................................................................................... 25 References ........................................................................................................... 27 Annex 1. Integrated Management of Childhood Illness (IMCI) impact model ..... 28 Annex 2. Vignettes from selected countries ......................................................... 29 Albania – IMCI review .......................................................................................... 29 Armenia – IMCI review ......................................................................................... 33 Azerbaijan – IMCI review ...................................................................................... 38 Georgia – IMCI review.......................................................................................... 43 Kazakhstan – IMCI review .................................................................................... 46 Kyrgyzstan – IMCI review ..................................................................................... 51 The Republic of Moldova – IMCI review ................................................................. 55 The Russian Federation – IMCI review ................................................................... 59 Tajikistan – IMCI review ....................................................................................... 63 Turkey – IMCI review ........................................................................................... 66 Ukraine – IMCI review .......................................................................................... 69 Uzbekistan – IMCI review ..................................................................................... 73 Annex 3. Vignettes from selected areas……………………………………………………86 Kosovo (in accordance with United nations Security Council Resolution 1244 (1999)) - IMCI review
Table 2 (contd)
s
Cough
Diarrhoea
Fever
Young infant
Counselling, health promotion
Nurse without right to Assess, refer fast prescribe breathing IMCI minus
Assess, manage watery diarrhoea
Assess and refer
Assess and refer, counsel feeding problems
Breast feeding, nutrition, danger signs, when to seek care, care for development
Nurse with right to prescribe/ feldsher IMCI
Treat dysentery, treat severe dehydration
Differential diagnosis, possible sepsis
Diagnosis of developmental delay, failure to thrive
Observation & management of possible sepsis, jaundice, LBW
Lab tests, further diagnostic tests
Treat pneumonia
Family doctor, general practitioner IMCI plus
Paediatrician
Assess child with fever, viral illness, UTI, ear infection, sore throat, urine dip sticks Differential diagnosis pneumonia, bronchiolitis, asthma
Differential diagnosis persistent diarrhoea, diarrhoea and malnutrition
Hospital Viral tests, x-ray, CRP
Viral tests, CRP
IMCI Introduction/Planning Improved drug availability, supervision, other health system improvements
Training of health workers/follow up visits
ITNs,* other family and community interventions
Improved quality of care in health facilities Improved careseeking, increased utilization
Improved household compliance/care
Improved health/nutrition
7
The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan
World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel: +45 45 33 70 00 Fax: +45 45 33 70 01 Email:
[email protected] Website: www.euro.who.int
