title: Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana.
abstract: BACKGROUND
  Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions.
  
  
  METHODS
  A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data.
  
  
  RESULTS
  The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy.
  
  
  CONCLUSIONS
  The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana.
authors.affiliation: Department of Health Studies, University of South Africa, Pretoria, South Africa.|School of Public Health, Department of Health Promotion and Education, Boitekanelo College, Gaborone, Botswana.
authors.forename: Lucia U
authors.initials: LU
authors.lastname: Mupara
authors.affiliation: Department of Health Studies, University of South Africa, Pretoria, South Africa; irenelubbe@icloud.com.
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Lubbe
mesh_terms: D001902:Botswana / Q000453:epidemiology; D002662:Child Health Services / Q000458:organization & administration; D046688:Child Mortality; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D019468:Disease Management; D005260:Female; D006282:Health Personnel / Q000193:education; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D011634:Public Health; D011795:Surveys and Questionnaires; D014944:World Health Organization
keywords: IMCI; Millennium Development Goals; children under 5 years; implementation challenges; registered nurses