IMCI approach in tertiary hospitals, India.
OBJECTIVE
This study was conducted to compare physicians' diagnosis with Integrated Management of Childhood Illness (IMCI) algorithm generated diagnosis in hospitalized children aged 2-59 months.


METHODS
Recruited were patients aged 2-59 months admitted with one or more IMCI danger signs. IMCI and physician's diagnosis were noted and compared.


RESULTS
In 222 included subjects, mean duration of illness was 9.4 (SD: 16.5) days. Among those with cough or difficult breathing, 44 (19.8%) and 66 (29.7%) were diagnosed as either severe pneumonia or mild to moderate pneumonia by physicians and IMCI algorithm, respectively (p= 0.015). Among 146 presenting as fever, 140 (95.9%) were diagnosed as very severe febrile disease by the IMCI algorithm, whereas physicians diagnosed these as either malaria in 10/146 (6.7%), pyogenic meningitis in 47/146 (32.2%), sepsis in 31/146 (21.3%), tuberculous meningitis in 17/146 (11.6%), encephalitis in 5/146 (3.4%), measles in 3/146 (2.1%) or others in 24/146 (16.4%).


CONCLUSIONS
As there was a low concordance between physician and IMCI algorithmic diagnosis of pneumonia (Kappa value= 0.74, 95% CI: (0.64-0.84)) and since very severe febrile disease is not a diagnosis made by the physicians, the IMCI algorithms have to be refined for appropriate management of these conditions.
Jain
Ritu
R
Department of Pediatrics, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India.
Awasthi
Shally
S
Awasthi
Avivar
A
D000465:Algorithms; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002675:Child, Preschool; D016001:Confidence Intervals; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D003906:Developing Countries; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006779:Hospitals, Public; D006801:Humans; D007194:India; D007223:Infant; D008288:Malaria / Q000175:diagnosis / Q000628:therapy; D008297:Male; D010372:Pediatrics / Q000592:standards / Q000639:trends; D011014:Pneumonia / Q000175:diagnosis / Q000628:therapy; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012720:Severity of Illness Index