Preferral Antibiotic Treatment Policy to be adopted in the 'Integrated Management of Childhood Illness Strategy in all  the Developing Countries?
OBJECTIVE
To review the rationale and practice for the use of single dose antibiotics in 'children below five years' as pre-referral treatment in the emergency triage and treatment protocol of IMCI in the developing countries and also, to assess the available evidence on the suitability of adopting the use of pre-referral antibiotic treatment as a standard strategy of Emergency Triage and Treatment (ETAT) in "Integrated Management of Childhood Illnesses" (IMCI) for all developing countries.


METHODS
Scientific, reliable information from the international articles (published and unpublished) were collected. A series of Medline search with key words were performed. Opinions of epidemiologists, public health officers and researchers University Alumni and senior health officials of some developing countries were included in this review.


RESULTS
Indirect evidence regarding for or against adopting pre-referral antibiotic treatment were found in developing countries where IMCI was implemented. It was also noted that the efficiency ranking based on the health system performance correlated negatively with the per capita income (r=-0.7, p=<0.001) and the per capita health expenditure. (r=-0.6, p=0.001). The gap between mortality rates of the '<1' and '1 to 4' years age groups was narrower in countries such as Oman and Argentina compared to the other developing countries. While the doctor population ratio was higher in countries with better efficiency rankings, (r=-0.66, p=0.01).


CONCLUSIONS
The differences found within the developing world indicate that the use of pre-referral antibiotic is certainly open to modification depending on the resources and health system performance.
Fannah
F
Al-Fannah
Rajiv
R
Khandekar
Padmamohan
P
Kurup
Samir
S
Shah