A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin.
OBJECTIVE
We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality.


METHODS
We conducted a randomized trial in Benin. We administered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence.


RESULTS
We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P < .05), and both groups outperformed untrained workers.


CONCLUSIONS
IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements.
Rowe
Alexander K
AK
Malaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, GA 30341-3724, USA. axr9@cdc.gov
Onikpo
Faustin
F
Lama
Marcel
M
Osterholt
Dawn M
DM
Rowe
Samantha Y
SY
Deming
Michael S
MS
D000293:Adolescent; D001541:Benin; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003906:Developing Countries / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010372:Pediatrics / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care / Q000592:standards; D014944:World Health Organization