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.

The effect of interrupted 5-day training on Integrated Management of Neonatal and Childhood Illness on the knowledge and skills of primary health care workers.

The conventional 8-day Integrated Management of Neonatal and Childhood Illness (IMNCI) training package poses several operational constraints, particularly due to its long duration. A 5-day training package was developed and administered in an interrupted mode of 3 days and 2 days duration with a break of 4 days in-between, in a district of Haryana state in northern India. Improvement in the knowledge and skills of 50 primary health care workers following the interrupted 5-day training was compared with that of 35 primary health care workers after the conventional 8-day IMNCI training package. The average score increased significantly (P < 0.05) from 46.3 to 74.6 in 8-day training and from 40.0 to 73.2 in 5-day training. Knowledge score improved for all health conditions, like anaemia, diarrhoea, immunization, malnutrition, malaria, meningitis and possible severe bacterial infection, and for breastfeeding in 8-day as well as in 5-day training. Average skills score for respiratory problems increased from 38 to 57 in 8-day training and from 41 to 91 in 5-day training. Corresponding increases in skill scores for diarrhoea assessment were from 28 to 67 and 48 to 75, and for breastfeeding assessment from 33 to 84 and 42 to 86 in 8-day and 5-day training, respectively. Average counselling skill score also rose from 42 to 89 in 8-day and from 37 to 70 in 5-day training. A direct cost saving of US$813 for a batch of 25 trainees and an indirect cost saving of 3 days per trainee and resource person makes the interrupted 5-day IMNCI training more cost-effective.