[Evaluation of integrated management of childhood illness three years after implementation in a health care district in Senegal].

The strategy of Integrated Management of Childhood Illness (IMCI) has been recommended by both WHO and UNICEF for first-level health facilities to control the main childhood diseases in developing countries. In Senegal, IMCI was adopted in 1996 and had been implemented in several pilot health districts by the year 2000. This study was conducted three years after implementation of IMCI in the Darou Mousty health district. The purpose was to evaluate determinant factors for implementation as well as the required skills of personnel. Evaluation was based on a review of IMCI records at health care facilities in the District and a survey to collect the opinion of healthcare workers involved in the program. All qualified personal, i.e. two doctors, eleven nurses and one midwife at the time of the survey, had received training in the IMCI approach. Although they all stated that this training improved their skills in managing paediatric patients, only 16 % used the approach on a regular basis. The most frequently reported reason for non-use was unwieldiness of IMCI procedures. According to IMCI guidelines, proper procedures were used in only 53 of the 1465 children (3.6%) who consulted during the study period. This low compliance rate was due to the inability of healthcare personnel to apply therapeutic protocols, plan appointments or identify emergency cases. These findings suggest that basic training and in-service courses must place greater emphasis on IMCI procedures and that regular supervision is needed to optimize this strategy in Senegal.