Health worker performance after training in integrated management of childhood illness--Western Province, Kenya, 1996-1997.

Each year, approximately 12 million children die in developing countries before age 5 years; 70% of these deaths are caused by respiratory infections, diarrhea, malaria, measles, and malnutrition, alone or in combination. In 1994, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) developed the Integrated Management of Childhood Illness (IMCI) guidelines, which call for non-physician health workers (HWs) to evaluate every sick child presenting to a first-level health facility (HF) for each of these conditions, regardless of the child's presenting complaint(s). Even though IMCI is being incorporated into the national health-care programs of many developing countries, little is known about HW performance after IMCI training. To measure the level of performance achieved and maintained by IMCI-trained HWs, during 1996-1997 CDC, the Kenya-Finland Primary Health Care Program, and the Ministry of Health of Kenya prospectively evaluated the level of performance achieved by IMCI-trained HWs at the end of training (EOT) and the level of performance maintained during the first 3 months post-training (1-3MPT) with monthly or bimonthly clinical supervision. This report summarizes the results of this evaluation, which indicate that HWs achieved reasonably high performance levels managing ill children with mild and moderate disease classifications but performed at a much lower level when managing severely ill children at EOT.