Objectives: Examine primary health care services for ill children in a sub-Saharan African country, assess the appropriateness of the Integrated Management of Childhood Illness (IMCI) in such a setting and evaluate its implementation.
Material and methods: The study was carried out in March, 2005 in the Monkey Bay area, Malawi, in two state-run health facilities that provide services free of charge and in three privately run facilities that charge user fees. Data was collected from each facility regarding all out-patient visits but in particular of children under five years of age (U5s). Interviews were conducted with health workers and drug inventories were carried out in the facilities.
Results: Eight out of 10 health workers were trained in IMCI. It was 1.22 times more likely (RR, 95% CI 1.18-1.26) that U5s were brought to a state-run facility than a private one. Around 4/5 of all disease classifications during the research period are dealt with in the IMCI. About half of U5s were classified with malaria, 28% with other respiratory infections, 6% with pneumonia, and 5% with diarrhoea. Most IMCI-recommended drugs were in stock at the time of inspection but all facilities lacked at least one recommended drug.
Conclusion: Results show that IMCI reaches the periphery of the health care system in a low-income country such as Malawi. They confirm that IMCI deals with the majority of diseases affecting U5s in such a setting. User fees seem to influence health care seeking behaviour. It is important to support and strengthen health services for ill children in the area, support continuous education of staff and ensure availability of drugs and equipment.