title: Evaluation of validity of Integrated Management of Childhood Illness guidelines in identifying edema of nutritional causes among Egyptian children.
abstract: OBJECTIVE
  The aim of this study was to assess the validity of the Integrated Management of Childhood Illness (IMCI) algorithm to detect edematous type of malnutrition in Egyptian infants and children ranging in age from 2 months to 5 years.
  
  
  METHODS
  This study was carried out by surveying 23 082 children aged between 2 months and 5 years visiting the pediatric outpatient clinic, Ain Shams University Hospital, over a period of 6 months. Thirty-eight patients with edema of both feet on their primary visit were enrolled in the study. Every child was assessed using the IMCI algorithm 'assess and classify' by the same physician, together with a systematic clinical evaluation with all relevant investigations.
  
  
  RESULTS
  Twenty-two patients (57.9%) were proven to have nutritional etiology. 'Weight for age' sign had a sensitivity of 95.5%, a specificity of 56%, and a diagnostic accuracy of 78.95% in the identification of nutritional edema among all cases of bipedal edema. Combinations of IMCI symptoms 'pallor, visible severe wasting, fever, diarrhea', and 'weight for age' increased the sensitivity to 100%, but with a low specificity of 38% and a diagnostic accuracy of 73.68%.
  
  
  CONCLUSIONS
  Bipedal edema and low weight for age as part of the IMCI algorithm can identify edema because of nutritional etiology with 100% sensitivity, but with 37% specificity. Revisions need to be made to the IMCI guidelines published in 2010 by the Egyptian Ministry of Health in the light of the new WHO guidelines of 2014.
authors: aPediatrics Department bCommunity Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors: Safinaz A
authors: SA
authors: El Habashy
authors: Maha H
authors: MH
authors: Mohamed
authors: Dina A
authors: DA
authors: Amin
authors: Diaa
authors: D
authors: Marzouk
authors: Mohammed N
authors: MN
authors: Farid
mesh_terms: D000465:Algorithms; D002675:Child, Preschool; D019468:Disease Management; D004487:Edema / Q000175:diagnosis* / Q000209:etiology*; D004534:Egypt; D005260:Female; D005534:Foot Diseases / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D009748:Nutrition Disorders / Q000150:complications* / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity