OBJECTIVES: To review the rationale and practice for the use of single dose antibiotics in 'children below five years' as pre-referral treatment in the emergency triage and treatment protocol of IMCI in the developing countries and also, to assess the available evidence on the suitability of adopting the use of pre-referral antibiotic treatment as a standard strategy of Emergency Triage and Treatment (ETAT) in "Integrated Management of Childhood Illnesses" (IMCI) for all developing countries. METHODS: Scientific, reliable information from the international articles (published and unpublished) were collected. A series of Medline search with key words were performed. Opinions of epidemiologists, public health officers and researchers University Alumni and senior health officials of some developing countries were included in this review. RESULTS: Indirect evidence regarding for or against adopting pre-referral antibiotic treatment were found in developing countries where IMCI was implemented. It was also noted that the efficiency ranking based on the health system performance correlated negatively with the per capita income (r=-0.7, p=<0.001) and the per capita health expenditure. (r=-0.6, p=0.001). The gap between mortality rates of the '<1' and '1 to 4' years age groups was narrower in countries such as Oman and Argentina compared to the other developing countries. While the doctor population ratio was higher in countries with better efficiency rankings, (r=-0.66, p=0.01). CONCLUSION: The differences found within the developing world indicate that the use of pre-referral antibiotic is certainly open to modification depending on the resources and health system performance.
OBJECTIVES: To review the rationale and practice for the use of single dose antibiotics in 'children below five years' as pre-referral treatment in the emergency triage and treatment protocol of IMCI in the developing countries and also, to assess the available evidence on the suitability of adopting the use of pre-referral antibiotic treatment as a standard strategy of Emergency Triage and Treatment (ETAT) in "Integrated Management of Childhood Illnesses" (IMCI) for all developing countries. METHODS: Scientific, reliable information from the international articles (published and unpublished) were collected. A series of Medline search with key words were performed. Opinions of epidemiologists, public health officers and researchers University Alumni and senior health officials of some developing countries were included in this review. RESULTS: Indirect evidence regarding for or against adopting pre-referral antibiotic treatment were found in developing countries where IMCI was implemented. It was also noted that the efficiency ranking based on the health system performance correlated negatively with the per capita income (r=-0.7, p=<0.001) and the per capita health expenditure. (r=-0.6, p=0.001). The gap between mortality rates of the '<1' and '1 to 4' years age groups was narrower in countries such as Oman and Argentina compared to the other developing countries. While the doctor population ratio was higher in countries with better efficiency rankings, (r=-0.66, p=0.01). CONCLUSION: The differences found within the developing world indicate that the use of pre-referral antibiotic is certainly open to modification depending on the resources and health system performance.
Authors: M Makinen; H Waters; M Rauch; N Almagambetova; R Bitran; L Gilson; D McIntyre; S Pannarunothai; A L Prieto; G Ubilla; S Ram Journal: Bull World Health Organ Date: 2000 Impact factor: 9.408