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Pediatria - Universidade Federal do Rio de Janeiro - Brazil Integrated care of childhood disease in Brazil: Mothers’ response to the recommendations of health workers Antonio J.L.A. CUNHA1, Silvia Reis DOS SANTOS2 & Jose MARTINES3 1 Institute of Paediatrics, IPPMG & Department of Paediatrics, Federal University of Rio de Janeiro, Brazil, 2 Institute of Paediatrics, IPPMG, Federal University of Rio de Janeiro, Brazil 3 Department of Child and Adolescent Health and Development, World Health Organization, Switzerland Aim: To describe the process of follow-up in primary care facilities where the Integrated Management of Childhood Illness (IMCI) strategy was implemented. IMCI was developed by WHO and UNICEF as an integrated approach to manage sick children under 5 y of age and aims to reduce mortality and morbidity. Methods: From August 2001 to February 2002, 229 sick children who had a health condition included in the IMCI case management guidelines were seen in six family healthcare facilities in Brazil. We analysed the care provided to 153 children who were recommended for a 2- or 5-d follow-up visit. Children who did not return were visited and assessed at home. Results: Only 87 children (56.9%) timely returned for followup: 70 had improved, eight presented the same health conditions, five were worse and four had a new problem. The main reasons given for not returning for follow-up were: the child had improved (35.1%) and other family priorities (47.4%). Home visits showed that, although most children had improved (n=49), some had a new health problem and one child was sick enough to be referred. Prescription of antibiotics was associated with increased probability of returning for a follow-up visit (RR =1.64 [1.22–2.20], p=0.001). Table. Follow-up interval recommended by health workers (n=229) (intervals recommended in IMCI guidelines in bold letters). follow-up interval 2 days 5 days >5 days Cough or cold * 2 2 1 1w -2mo Feeding probl./low weight/ thrush 1 0 3 (n=10) Local bacterial infection 0 0 1 Diarrhea ** 0 0 0 Cough or cold * 11 21 11 Pneumonia 28 5 3 Acute ear infection 0 19 10 Fever * 23 2 1 Diarrhea without dehydration ** 8 14 2 Very low weight 0 2 19 2mo up 5y Anemia 0 1 19 (n=219) Feeding problems 1 3 4 Diarrhea with dehydration ** 2 4 0 Chronic ear infection 0 1 2 Persistent diarrhea 2 1 0 Dysentery 0 0 0 Total 78 75 76 Health condition * Follow-up in 2 days if not better Total 5 4 1 0 43 36 29 26 24 21 20 8 6 3 3 0 229 Sick children from 0 to 5 years n=305 IMCI case management guidelines health problems n=229 Health worker recommended 2 to 5-day follow-up visit n=153 Returned for follow-up? 56.9% n=87 YES Pneumonia Acute ear infection NO n=66 Cold Diarrhea Home visits=57 Same Worse=5 New Improved problem=8 problem=4 =70 9.3% 5.7% 4.6% 80.4% 43.1% Main reasons for not returning for FU: • Child improved n=20 • Other priorities n=27 Health worker assessment Improved=49 86.0% Worse=1 New problem = 7 1.7% 12.3% Figure. The process of follow-up and constraints **Follow-up in 5 days if not better Conclusion: Adherence to follow-up was just over 50%, mostly because the condition had already resolved, but some children were still sick and needed intervention. Training on counselling on the recognition of danger signs and when to return for a follow-up visit must be reinforced. This investigation was suported by WHO Email: [email protected]