Integrated care of childhood disease in Brazil: mothers' response to the recommendations of health workers.
OBJECTIVE
To describe the process of follow-up in primary care facilities where the Integrated Management of Childhood Illness (IMCI) strategy was implemented. IMCI was developed by WHO and UNICEF as an integrated approach to manage sick children under 5 y of age and aims to reduce mortality and morbidity.


METHODS
From August 2001 to February 2002, 229 sick children who had a health condition included in the IMCI case management guidelines were seen in six family healthcare facilities in Brazil. We analysed the care provided to 153 children who were recommended for a 2- or 5-d follow-up visit. Children who did not return were visited and assessed at home.


RESULTS
Only 87 children (56.9%) timely returned for follow-up: 70 had improved, eight presented the same health conditions, five were worse and four had a new problem. The main reasons given for not returning for follow-up were: the child had improved (35.1%) and other family priorities (47.4%). Home visits showed that, although most children had improved (n=49), some had a new health problem and one child was sick enough to be referred. Prescription of antibiotics was associated with increased probability of returning for a follow-up visit (RR =1.64 [1.22-2.20], p=0.001).


CONCLUSIONS
Adherence to follow-up was just over 50%, mostly because the condition had already resolved, but some children were still sick and needed intervention. Training on counselling on the recognition of danger signs and when to return for a follow-up visit must be reinforced.
Cunha
Antonio J L A
AJ
Institute of Paediatrics, IPPMG and Department of Paediatrics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. acunha@hucff.ufrj.br
dos Santos
Sílvia Reis
SR
Martines
José
J
D001938:Brazil; D019090:Case Management / Q000458:organization & administration*; D002662:Child Health Services / Q000592:standards* / Q000639:trends; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D004194:Disease; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006266:Health Education / Q000592:standards; D006282:Health Personnel; D006287:Health Planning Guidelines; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009034:Mother-Child Relations; D010349:Patient Compliance / Q000706:statistics & numerical data; D011336:Probability; D015397:Program Evaluation; D012016:Reference Values; D012307:Risk Factors