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Medical Management Reduces Childhood Deaths in Developing World


Dozens of developing countries have in recent years adopted a strategy aimed at reducing childhood illnesses and death. Called Integrated Management of Childhood Illnesses (IMCI). The U.N. sponsored program has been in effect since the mid-1990s, but investigators have just released studies of the effectiveness of IMCI in two countries.

The purpose of Integrated Management of Childhood Illnesses is to make sure children under age five receive the full range of health care services to keep them from dying of preventable diseases. Experts say 10 million children die each year from such illnesses as malaria, pneumonia, diarrhea, measles, and malnutrition.

Traditionally, global health organizations have fought these diseases by conducting high profile, single-disease campaigns such as "Rollback Malaria". But experts say that approach leaves other health care needs unmet, and many local health workers remain ill-equipped to carry out single-program goals.

Ten-years ago, the World Health Organization (WHO) endorsed a new strategy, Integrated Management of Childhood Illnesses (IMCI). It is a community-based plan for dealing with a range of pressing pediatric health care needs.

IMCI involves three components: Community education, training health care workers and strengthening clinical facilities.

Recently, the international medical journal The Lancet published two studies looking at the effectiveness of IMCI in communities in Tanzania and Bangladesh.

The studies found that the first efforts of IMCI to educate families about children's' health did not get them to seek medical care. But according to health policy analyst Davidson Gwatkin, what encouraged families to seek medical care was knowing they would get improved health care at better-equipped medical facilities.

"We are not talking about high-tech hospitals," he said. "We are talking about a little one or two room facility with a high-school educated trained person, if that, …knowing how to treat the most six or eight common childhood diseases."

The studies also show IMCI costs the same as other health care programs in the developing world.

But while IMCI appears to work when tried at a few facilities, Mr. Gwatkin says the biggest unknown is whether it would be possible to train enough health workers to treat millions of people in entire countries.

"The question is just in how many places in the world with poor health systems can it be done right?" he asked.

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