Quality and use of IMNCI services at health center under-five clinics after introduction of integrated community-based case management (ICCM) in three regions of Ethiopia.

BACKGROUND: The Integrated Management of New born and Childhood Illness (IMNCI) and the related Integrated Community Case Management (iCCM) are evidence-based strategies to reduce childhood mortality in Ethiopia at health centres and community health posts, respectively. The effect of introducing iCCM on IMNCI is not known.

OBJECTIVE: To assess the caseload and quality of lMNCI service in under-five clinics in health centres after iCCM implementation.

METHODS: This cross-sectional study used register review to assess the IMNCI service use (before and after iCCM, in 2010 and 2012, respectively) and quality throughout the period in randomly selected health centers in three regions of the Integrated Family Health Program (Oromia, SNNPR [Southern Nations and Nationalities and Peoples Region] and Tigray).

RESULTS: Caseload of sick children at 28 health centers increased by 16% after iCCM implementation (21,443 vs. 24,882 children in 2010 and 2012, respectively. The consistency of IMNVCI treatment with classification for pneumonia, diarrhea and malaria was low (78, 45, and 67%, respectively) compared to iCCM treatment (86, 80, and 91%, respectively).

CONCLUSION: Health center case load increased modestly after iCCM was introduced, but was lower than expected, even when combined with health post use from other studies. The demand strategy for sick children needs review. The quality of IMNCI needs improving even to bring it to the quality of iCCM at health posts, as measured by the same methods. Successful quality assurance approaches from iCCM, e.g., the Performance Review and Clinical Mentoring Meeting, could be adapted for IMNCI.