title: Improving and sustaining quality of child health care through IMCI training and supervision: experience from rural Bangladesh.
abstract: BACKGROUND
  The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities.
  
  
  OBJECTIVE
  To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision.
  
  
  METHODS
  Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities.
  
  
  RESULTS
  Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities.
  
  
  CONCLUSIONS
  IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA emdad@icddrb.org emdadas@gamil.com.
authors.forename: D M Emdadul
authors.initials: DM
authors.lastname: Hoque
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Shams E
authors.initials: SE
authors.lastname: Arifeen
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Muntasirur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Enayet K
authors.initials: EK
authors.lastname: Chowdhury
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Twaha M
authors.initials: TM
authors.lastname: Haque
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Khadija
authors.initials: K
authors.lastname: Begum
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: M Altaf
authors.initials: MA
authors.lastname: Hossain
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Tasnima
authors.initials: T
authors.lastname: Akter
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Fazlul
authors.initials: F
authors.lastname: Haque
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Tariq
authors.initials: T
authors.lastname: Anwar
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Sk Masum
authors.initials: SM
authors.lastname: Billah
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Ahmed Ehsanur
authors.initials: AE
authors.lastname: Rahman
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Md Hamidul
authors.initials: MH
authors.lastname: Huque
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Aliki
authors.initials: A
authors.lastname: Christou
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bryce
authors.affiliation: Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D001459:Bangladesh; D019090:Case Management / Q000592:standards; D000067576:Child Health; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000592:standards; D005260:Female; D006268:Health Facilities; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000193:education; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D012424:Rural Population
keywords: Child health services; health care; health facility survey; quality indicators; quality of care