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IMCI Tanzania
%20Work%20in%20TZ%20small%20pic.JPG) An estimated 10 million children die each year from preventable or treatable causes. (Black, 2003) Most could be saved by the correct application of simple standards of care such as the IMCI protocols for classifying and treating common causes of death including pneumonia, diarrhoea, malaria, measles, and malnutrition. However, despite a worldwide effort, the use of IMCI protocols remains limited due to the expense of training, the lack of sufficient supportive supervision, and the tendency to follow protocols less rigorously over time. Further, the difficulty of updating protocols has contributed to the use of treatments for malaria and other diseases long past the point where they are no longer effective. (see our work on Malaria) Vastly more effort has gone into developing standardized treatments than developing innovative and effective methods to deploy them.
D-Tree International has been working in the area of child health to improve the flexibility and use of IMCI protocols through the development of and electronic version of IMCI (eIMCI) for use on cell phones and other mobile devices. We have piloted e-IMCI in rural Tanzania where our initial results indicate that clinicians more closely adhere to the IMCI protocol when using e-IMCI than without it and were enthusiastic about its use with patients. The software we have developed runs on a PDA and guides health workers step-by-step through the full IMCI assessment, classification and treatment plan. The software was designed for ease of use and the training of clinicians took less than 1 hour in all cases. This work was supported by a generous grant from the World Health Organization and the Rockefeller Foundation.
We are currently undergoing a large scale study to validate these initial findings that e-IMCI leads to improved adherence to the IMCI protocols compared to the conventional use of IMCI. We are also looking at the cost and cost-effectiveness of e-IMCI compared to the conventional paper based IMCI. This study, being conducted in Tanzania in collaboration with the Ifakara Health Research and Development Centre will be completed in 2009.
In addition to our work on IMCI protocols, we are using the mobile technology to store information about each child including immunization records and growth history, and will prompt the worker with opportunities for preventative care. This same record will also be an invaluable source of data, as the aggregated patient records will provide managers with information about provider workload, childhood disease patterns, and immunization levels.
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