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Compliance, workload, and the cost of using the Integrated Management of Childhood Illness algorithm in Niger.

Kelley E | Geslin C | Djibrina S | Boucar M
Organization: Quality Assurance Project/URC

Region and Country: Africa, Sub Saharan, Niger


Previous studies have reported that increased compliance with IMCI guidelines is associated with longer client-provider interaction times and lower drug costs. This paper presents the results of a study of the relationship between IMCI compliance and interaction time, drug costs, and workload in 26 health clinics in Niger. Trained observers measured compliance of IMCI-trained nurses using a modified version of the WHO-BASICS Health Facility Assessment. The observers recorded interaction times for 211 child cases of fever, cough, diarrhea, and earache presenting at the clinics in December 1998. Prescription records for these cases were obtained several months later and considered in combination with the IMCI-recommended dose and the unit cost of the drug. The study found compliance rates as follows: 33 percent for assessment, 81 percent for treatment, and 42 percent for counseling. No relationship was found between compliance and drug cost, even for particular diagnoses, although other factors were associated with drug costs. Also, no relationship was found between compliance and interaction time or between average clinic workload and average clinic compliance. Thus, the study counters previous findings, although limitations are described in the text. (author's)