Evaluation of an algorithm for integrated management of childhood illness in an area of Vietnam with dengue transmission.
OBJECTIVE
To determine whether nurses, using the WHO/UNICEF algorithm for integrated management of childhood illness (IMCI), modified to include dengue infection, satisfactorily classified children in an area endemic for dengue haemorrhagic fever (DHF).


METHODS
Nurses assessed and classified, using the modified IMCI algorithm, a systematic sample of 1250 children aged 2 months to 10 years (n = 1250) presenting to a paediatric hospital in Dong Nai Province, Vietnam. Their classification was compared with that of a paediatrician, blind to the result of the nurses' assessment, which could be modified in the light of simple investigations, e.g. dengue serology.


RESULTS
In children aged 2-59 months (n = 859), the nurses were able to classify, using the modified chart, the presenting illness in >99% of children and found more than one classification in 70%. For the children with pneumonia, diarrhoea, dengue shock syndrome, severe DHF and severe disease requiring urgent admission, the nurse's classification was >60% sensitive and >85% specific compared with that of the paediatrician. For the nurse's classification of DHF the specificity was 50-55% for the children <5 years and in children with definitive dengue serology. Alterations in the DHF algorithm improved specificity at the expense of sensitivity.


CONCLUSIONS
Using the IMCI chart, nurses classified appropriately many of the major clinical problems in sick children <5 years in southern Vietnam. However, further modifications will be required in the fever section, particularly for dengue. The impact of using the IMCI chart in peripheral health stations remains to be evaluated.
Cao
Xuan Thanh Phuong
XT
Dong Nai Paediatric Centre, Bien Hoa, Vietnam.
Ngo
Thi Nhan
TN
Kneen
Rachel
R
Bethell
Delia
D
Le
Thi Dep
TD
Nguyen
Thi Thuy Nga
TT
Pham
Thi Thu Thuy
TT
Truong
Dinh Luat
DL
Solomon
Tom
T
Wills
Bridget
B
Parry
Christopher M
CM
D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009726:Nurses / Q000592:standards*; D012680:Sensitivity and Specificity; D019595:Severe Dengue / Q000175:diagnosis / Q000451:nursing*; D014744:Vietnam