Integrated Management of Neonatal and Childhood Illness (IMNCI): skill assessment of health and Integrated Child Development Scheme (ICDS) workers to classify sick under-five children.

OBJECTIVE: To assess the skills (diagnostic/counseling) of Integrated Management of Neonatal and Childhood Illness (IMNCI) trained workers; and to assess the degree of agreement between the physician and the IMNCI trained workers of Raipurrani block, district Panchkula, India, to classify sick under-five children in field.
METHODS: The cross-sectional study was conducted in Raipurrani in the outpatient departments of the community health centre and one primary health centre in 2010. Workers from health department and Integrated Child Development Scheme (ICDS) were assessed in this study. They received IMNCI training in 2006, with 1 day refresher training in 2009. Investigator noted his observations using a skill assessment checklist. Under-five child observations were the unit of study.
RESULTS: Sixteen IMNCI trained workers made 128 child observations. Considering color-coded categorization under IMNCI, agreement with investigator (Kappa) was intermediate; red and yellow categorizations had poor agreement. Morbidity-wise agreement (Kappa) was poor for possible serious bacterial infection, feeding problem, respiratory problem and anemia. Considering final diagnosis, investigator and IMNCI trained worker completely agreed in 45 % child observations. All symptoms were asked only in 15 %. Skills were poor overall for young infants. For children between 2 mo to 5 y, danger signs, neck stiffness, edema, wasting and pallor were checked in <40 % observations. Immunization card was asked for in 20 % observations. IMNCI trained workers performed well in all aspects of counseling, except follow up.
CONCLUSIONS: Training without effective implementation plans will not result in long term skill retention.