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-- IMCI Impact on Child Mortality, Egypt

Sunday, 10th of February 2013

•  IMCI IMPACT ON CHILD MORTALITY, EGYPT

Does implementation of the IMCI strategy have an impact on child mortality? A retrospective analysisof routine data from Egypt

 

Mona Ali Rakha,1 Ahmed-Nagaty Mohamed Abdelmoneim,1 Suzanne Farhoud,2 Sergio Pièche,2 Simon Cousens,3 Bernadette Daelmans,4 Rajiv Bahl4

 

BMJ Open 2013;3

 

1General Administration of Childhood Illness Programs, Primary Health Care Sector,

Ministry of Health and Population, Cairo, Egypt

2Child and Adolescent Health (CAH), World Health Organization, Regional Office

for the Eastern Mediterranean, Cairo, Egypt

3London School of Hygiene and Tropical Medicine, London, UK

4Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland

Correspondence to

Dr Mona Ali Rakha; mona_rakha@yahoo.com

 

Full text is at http://bmjopen.bmj.com/content/3/1/e001852.long 

ABSTRACT

Background: Between 1999 and 2007, the Ministry of Health and Population in Egypt scaled up the Integrated Management of Childhood Illness (IMCI) strategy in 84% of public health facilities.

 

Objectives: This retrospective analysis, using routinely available data from vital registration, aimed to assess the impact of IMCI implementation between 2000 and 2006 on child mortality. It also presents a systematic and comprehensive approach to scaling-up IMCI interventions and information on quality of child health services, using programme data from supervision and surveys.

 

Methods: We compared annual levels of under-five mortality in districts before and after they had started implementing IMCI. Mortality data were obtained from the National Bureau for Statistics for 254 districts for the years 2000–2006, 41 districts of which were excluded. For assessment of programme activities, we used information from the central IMCI data base, annual progress reports, follow-up after training visits and four studies on quality of child care in public health facilities.

 

Results: Across 213 districts retained in the analysis, the estimated average annual rate of decline in underfive mortality was 3.3% before compared with 6.3% after IMCI implementation (p=0.0001). In 127 districts which started implementing IMCIbetween 2002 and 2005, the average annual rate of decline of under-five mortality was 2.6% (95% CI 1.1% to 4.1%) before compared with 7.3% (95% CI 5.8% to 8.7%) after IMCI implementation (p<0.0001). IMCI implementation also led to marked improvements in the quality of child health services.

 

Interpretation: IMCI implementation was associated with a doubling in the annual rate of under-five mortality reduction (3.3% vs 6.3%). This mortality impact is plausible, since substantial improvements occurred in quality of care provided to sick children in health facilities implementing IMCI.